Heart Health Survey
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First Name *
Your answer
Last Name
Your answer
Email *
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Have have you been diagnosed with heart failure? If Yes How Long? *
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Do you have any of the following conditions? *
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How often do you visit a cardiologist? *
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Who influences your treatment plan the most? *
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What medications do you currently take? *
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Please indicate the extent to which you agree or disagree with the following statement: BlackDoctor.org provides me with relevant health information I can’t find elsewhere: *
Which of the following cardiovascular conditions, if any, have you been professionally diagnosed with (select all that apply):* *
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