Question 1/14

How would you rate your cholesterol?

Question 2/14

How do you rate your following:

LDL (Bad Cholesterol)

Triglycerides

HDL (Good Cholesterol)

Question 3/14

How often do you have your cholesterol checked?

Yearly
Twice a year
Almost never

Question 4/14

Based on your family history, are you at risk for the following?

Question 5/14

Do you currently suffer from any of the following ailments? (click all that apply)

Question 7/14

Are you currently satisfied with your treatment?

Yes
No

Question 8/14

Please explain why are you dissatisfied with your current treatment

Question 9/14

Are you interested in changing your treatment?

Yes
No

Question 10/14

What treatment(s) are you interested in switching to

Question 11/14

Do you currently have medical insurance?

Yes
No

Question 12/14

Please select your current medical provider

Question 13/14

What is the name of your provider?

Question 14/14

lease select the current medical coverage you have