Patient Questionnaire- Cholesterol Studies

100% of survey complete.

Question Title

1. Contact Information (Required.)

Name

E-mail

Phone Number with Area Code

City

Birthdate

Question Title

2. Have you been diagnosed with high cholesterol? (Required.)

Yes

Don't Know

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3. What was your most recent LDL value?

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4. Has your doctor told you that you have high triglycerides? (Required.)

Yes

Don't Know

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5. What was your most recent triglyceride value?

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6. Do you take medication for your cholesterol?

Lipitor (atorvastatin)

Crestor (rosuvastatin)

Zocor (simvastatin)

Pravachol (pravastatin)

Mevacor (lovastatin)

Zetia (ezetimibe)

Lopid (gemfibrozil)

Do not take any medication

Other (please specify)

Question Title

7. What other medical conditions do you have?

Diabetes (Type I)

Diabetes (Type II)

High blood pressure (Hypertension)

Overweight or Obese

Heart Attack

Other (Please list)

Patient Questionnaire- Cholesterol Studies

Question Title

1. Contact Information (Required.)

Question Title

2. Have you been diagnosed with high cholesterol? (Required.)

Question Title

3. What was your most recent LDL value?

Question Title

4. Has your doctor told you that you have high triglycerides? (Required.)

Question Title

5. What was your most recent triglyceride value?

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6. Do you take medication for your cholesterol?

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7. What other medical conditions do you have?

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8. How tall are you?

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9. How much do you weigh (in pounds)?

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* 1. Contact Information (Required.)

Question Title

* 2. Have you been diagnosed with high cholesterol? (Required.)

Question Title

* 3. What was your most recent LDL value?

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* 4. Has your doctor told you that you have high triglycerides? (Required.)

Question Title

* 5. What was your most recent triglyceride value?

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* 6. Do you take medication for your cholesterol?

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* 7. What other medical conditions do you have?

Question Title

* 8. How tall are you?

Question Title

* 9. How much do you weigh (in pounds)?

1. Contact Information (Required.)

2. Have you been diagnosed with high cholesterol? (Required.)

3. What was your most recent LDL value?

4. Has your doctor told you that you have high triglycerides? (Required.)

5. What was your most recent triglyceride value?

6. Do you take medication for your cholesterol?

7. What other medical conditions do you have?

8. How tall are you?

9. How much do you weigh (in pounds)?