Cardio Impact - Wonderfeelz LifStyles

THIS IS NOT TO DIAGNOSE YOUR CARDIOPULMONARY OR CARDIOVASCULAR DISORDER.

This tool is to rate on the Symptoms Severity and Severity of Impact related to Hypertension.

This tool is helpful to know the Impact of Hypertension and Assess the Effectiveness of Relaxation Techniques on the impact.

Name *

Date of Birth *

Phone *

Email Address *

Existing Diagnosis / Problem and Duration

1. Shortness of breath, In the past one week *

2. Fatigue, In the past one week *

3. Lack of energy, In the past one week *

4. Swelling in ankles or legs, In the past one week *

5. Swelling in stomach area, In the past one week *

6. Cough, In the past one week *

7. Heart palpitations (fluttering), In the past one week *

8. Rapid heartbeat, In the past one week *

9. Chest pain, In the past one week *

10. Chest tightness, In the past one week *

11. Lightheadedness, In the past one week *