Healthy
Charles County

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Healthy Hearts Start at Home

Healthy Hearts Start at Home

Please complete this enrollment form if you want to participate in the four-month blood pressure self-monitoring program.
 

Healthy Hearts Start at Home

"*" indicates required fields

Name
Date of Birth*
Sex
Were you diagnosed in the last 12 months with high blood pressure/hypertension?
Are you on medication to control your blood pressure?
Do you have Atrial Fibrillation (A fib) or other Arrhythmias?
Do you have or are at risk for Lymphedema?
Have you experienced a recent cardiac event within the last 12 months?
How would you classify your current activity level?
How often do you use alcohol?
1 For Often and 5 for Never
How often do you use tobacco?
1 For Often and 5 for Never
How often do you use caffeine?
1 For Often and 5 for Never
Do you have a computer and internet access?
How often do you use recreational drugs?
Do you currently have a working blood pressure monitor at home?
Weight in KG
Height in CM

How Do I...

4545 Crain Highway
White Plains, MD 20695
Phone: 301-609-6900
Hours: Mon-Fri 8 AM – 5 PM

ADMINISTRATION

Health Officer
Dianna E. Abney, M.D.

MISSION

To protect, promote, and improve the health, safety, and environment of Charles County residents.

VISION

A healthier Charles County

PARTNER LINKS

Charles County Government

Charles County Public Schools

Maryland Department of Health

University of Maryland Charles Regional Medical Center