Blood Pressure Self Regulating Participant inquiry

Blood Pressure Self Regulating Participant Inquiry

First Name *

Last Name *

Address

(Indiana Resident Only)

Street Address *

City *

State *

Zip Code *

Phone Number *

Email *

Branch Preference *

Why are you interested in the Blood Pressure Self Regulating Program? *

Are you eligible?

Please confirm you fill the following requirements for the YMCA Blood Pressure Self-Monitoring Program:

Age *

Be at least 18 years old

Diagnosis *

Be diagnosed with high blood pressure

Cardiac event *

Not have experience a recent cardiac event

Atrial Fibrillation *

Not have atrial fibrillation or other arrhythmias

Lymphedema *

Not be at risk for lymphedema

Leave this field blank