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Heart Health Assessment

Complete this form to assess your heart health risk factors

Personal Info

Biomarkers

Lifestyle

Additional

Results

Personal Information

Full Name

Your phone number

Your City

Your email

Age

Gender

Male Female

Height (cm)

Weight (kg)

Cardiovascular Biomarkers

Systolic Blood Pressure (mmHg)

LDL Cholesterol (mg/dL)

HDL Cholesterol (mg/dL)

Triglycerides (mg/dL)

hs-CRP (mg/L)

Lp(a) (nmol/L)

Homocysteine (μmol/L)

Fasting Glucose (mg/dL)

Fasting Insulin (μIU/mL)

HbA1c (%)

Lifestyle Factors

Do you smoke?

Alcohol Intake

Processed Food Intake

Fruit & Vegetable Intake

Physical Activity

Family History of Heart Disease

Air Pollution (AQI in your area)

Stress Level

Sleep Quality

Additional Information

On BP Medication

On Diabetes Medication

On Cholesterol Medication

Vitamin D Level (ng/mL)

Vitamin B12 Level (pg/mL)

Your Heart Risk Results

Total Risk Score

Low Risk Moderate Risk High Risk

What Your Results Mean

This risk assessment provides an indication of potential cardiovascular risk factors based on your inputs. A higher score suggests more risk factors present.

Important: This calculator is for informational purposes only and does not substitute for professional medical advice.

Next Steps

At PIVOT health we have a evidence based program for improving your Heart health click to know more