Heart Smart with LIVESMART Group Registration Form

Check It. Change It. Control It.

Dear LIVESMART Participant,

Thank you for your interest in the Heart Smart with LIVESMART campaign, as coordinated by your LIVESMART team. This campaign aims to help successfully prevent and manage hypertension.

We will meet as a group once a week throughout the month for a total of 4 sessions. These sessions will be held on Wednesdays at 11 am CST each week, beginning on February 7th. To optimize your benefit from this program, please be available to meet at one of these times for the majority of these sessions. If you are unable to attend a session, we will record them so you may view the missed session at your convenience.

Please fill out the form below to register.

If you have any questions at any time, do not hesitate to contact the LIVESMART team at connect@livesmartoni.com. We are looking forward to working with you!

Wishing you health and happiness,

Your LIVESMART Team

Question Title

* 1. Participant Information

First Name:

Last Name:

Email address:

Phone number:

Question Title

* 2. Company and Location | Spouses, please enter the location of your Spouse's workplace.

Question Title

* 3. Status

Employee

Spouse

Question Title

* 4. What is your primary motivation for participating in this campaign?

I want to prevent high blood pressure

I want to learn how to better manage my high blood pressure

I was recently diagnosed with high blood pressure and I want to learn more

A friend or family member was recently diagnosed with high blood pressure so I want to learn to be able to help them

Other (please specify)