Cure Hypertension Initial Survey
Dr. David Donohue of Progressive Health of Delaware will run a telehealth webinar for people with high blood pressure on Monday July 30 at 6:30pm to 8pm.

Please complete this survey before the talk to help us know a little about your current lifestyle habits and blood pressure status.
Your name *
Your answer
Your email
Your answer
Your phone number
If you prefer to be contacted by phone or text message, we need your phone number.
Your answer
What is your goal in attending this webinar?
Your answer
How can we best contact you?
I will attend the July 30 webinar on my
What YEAR did you first develop high blood pressure?
Your answer
Which BLOOD PRESSURE MEDICINES do you take regularly?
Your answer
Which OTHER medicines do you take regularly?
Your answer
Which vitamins or SUPPLEMENTS do you take regularly?
Your answer
What is your average systolic blood pressure (TOP number)?
Your answer
What is your average diastolic blood pressure (BOTTOM number)?
Your answer
What is your weight?
in pounds
Your answer
How many HOURS of SLEEP do you get per 24 hours, on average?
Your answer
What is your QUALITY of SLEEP?
Your answer
How many days a week do you engage in moderate to strenuous exercise (like a brisk walk)?
On the days that you exercise, how many minutes do you do moderate to strenuous exercise?
Your answer
How motivated are you to make changes in your daily habits?
Not at all
100%
How much do you...?
0% - Not at all
25% - Sometimes
50% - Half the time
75% - Most of the time
100% - almost always
Measure my blood pressure at home
Take my blood pressure medicines like I am supposed to
Take at least 1 of my blood pressure medicines at bedtime
Eat a whole foods, plant based diet
Practice meditation or mindfulness
Use RESPeRATE blood pressure device
To pay for this session, Progressive Health of Delaware plans to bill your health insurance for a telehealth session. In the case of Medicare patients, we will bill Medicare for Chronic Care Management. In any case, we do not plan to collect copay or deductible payment from you. Is this acceptable to you? *
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