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Blood Pressure Lending Library Agreement Form and Pre-Survey

The SLCo Employee Wellness Blood Pressure Lending Library Program is now accessible to all Salt Lake County Employees aiming to track their Blood Pressure levels on a daily basis for one month.
Before we begin, please take a moment to read thoroughly and complete the agreement form and the pre-survey. Answer the questions to the best of your knowledge. Our aim is to help you enhance your understanding of blood pressure and your own body's readings by monitoring your blood pressure daily and utilizing the resources we provide.
Please read through the following agreement form. Click on the BLUE BOLDED TEXT to read the form, then return to this survey to type your initials, to agree to the terms.
1.By initialing in the comment box below, I CONFIRM that I have read through the Blood Pressure Lending Library Agreement form and that I AGREE to the agreement form. (Please provide first and last name initials)
2.What is your first and last name?
3.What is your EIN (Employee ID Number)? If you are an adult designee, at + 1 to the end of your employee's number.
4.What is the best way to contact you?(Required.)
5.What is your contact information?
6.Watch the following video to learn how to take your Blood Pressure.
7.How did you hear about the Blood Pressure Lending Library? (Required.)
8.What is your age range? (Required.)
9.What is your gender?(Required.)
10.What race of ethnicity best descibes you?(Required.)
11.How often would you say that your meals eaten are well-balanced? (Emphasizes on vegetables, fruits, whole grain, dairy products, including lean meats, poultry, fish, beans, eggs and nuts. Limited on saturated and trans fats, sodium and added sugars.) (Required.)
12.Do you use tobacco products?(Required.)
13.What type of physical activity do you currently participate in?
14.How many minutes are you physically active each week?(Required.)
15.Have you talked with a doctor about your blood pressure recently? (Within the last 6 months) (Required.)
16.On a scale from 0-100, 0 being extremely unlikely, and 100 being extremely likely, how likely are you to talk with a doctor about your blood pressure currently?(Required.)
0
50
100
17.What is systolic pressure?(Required.)
18.What it diastolic pressure?(Required.)
19.What is the recommended systolic and diastolic numbers to fall at or below? (Required.)
20.What does hypotension mean?(Required.)
21.What does hypertension mean?(Required.)
22.When should you talk with a doctor about your blood pressure? Select all that apply. (Required.)