Jonnie's Goodguys Heart Scan Gift Card Application

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Please review the following requirements listed here:
https://iuhealth.org/find-medical-services/heart-scans

Name *

Email *

Phone number *

I have reviewed the requirements listed at the website above... *

Yes

For a Heart Scan - Are you between the ages of 40-79 and meet at least ONE of the following risk factors? (Family history of Heart Disease, Stroke and/or other vascular disease, Smoking, Diabetes, Obesity, High Blood Pressure) *

Yes

For a Vascular Scan - Are over the age of 50 and meet at least ONE of the following risk factors? (Family history of Abdominal Aortic Aneurysm, Heart Disease, and/or Stroke, High Blood Pressure, Smoking, High Cholesterol, Chronic Obstructive Pulmonary Disease) *

Yes

Where did you hear about Jonnie's Goodguys and/or this Heart Scan Application? *

Submit

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