Thank you for your interest in the upcoming Hypertension Management Program. This program will be available to a limited number of employees and this survey is designed to help us identify participants most in need of the program. Your honest responses will remain confidential. A member of the Employee Health and Wellness team will contact you shortly.

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* 1. First name:

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* 2. Last name:

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* 3. Texas Children's email address:

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* 4. Have you ever been diagnosed with high blood pressure or hypertension?

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* 5. Have you ever been told by a doctor, nurse, or other health care professional that you have elevated blood pressure or hypertension?

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* 6. Do you typically have blood pressure readings above 140/90?

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* 7. Do you currently take blood pressure medications?

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* 8. Are you able to commit to completing all five program appointments?
-One medical appointment (7:30 a.m. - 4:00 p.m.)
-Two individual nutrition consultations (8:00 a.m. - 4:00 p.m)
-Two 60 minute group sessions (noon and 4:00 p.m.)

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