Patient Questionnaire- Cholesterol Studies

100% of survey complete.

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* 1. Contact Information

Name

E-mail

Phone Number with Area Code

City

Birthdate

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* 2. Have you been diagnosed with high cholesterol?

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?

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)

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* 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

Question Title

* 2. Have you been diagnosed with high cholesterol?

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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?

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* 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)?