$125 Opinion Study

Name

Phone

E-Mail

State

Gender

Age

Yes

Yes

Atrial Fibrillation (or Nonvalvular AFib), a type of irregular heartbeat – NOT caused by a heart valve problem

Deep Vein Thrombosis (DVT: Blood clot in a vein, usually in the leg, thigh, or pelvis)

Pulmonary Embolism (PE: Blood clot in the lungs - one or more arteries in your lungs become blocked.)

Congestive Heart Failure

Type 2 Diabetes

Stroke or “Mini-Stroke”

High blood pressure or hypertension

ASCVD

Renal insufficiency (i.e. impaired kidney function)

Peripheral Artery Disease (PAD)

Coronary Artery Disease (CAD)

None of the above