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Are You at Risk for Stroke?


Sacred Heart Regional Stroke Center invites you to complete the Stroke Risk Assessment provided below. You do not need to return this assessment to us; simply fill it out and share it with your physician upon your next visit.

Self Family Medical History

(Check all that apply to you or to any blood relative,
such as parent, sibling, etc.)

Yes
No
Previous Stroke
Previous Mini-Stroke/TIA
Carotid Artery Disease
High Blood Pressure
Heart Disease
Atrial Fibrillation (heart rhythm disorder)
Heart Surgery
Diabetes
High Blood Cholesterol
Current Smoker (If yes, packs/day)
Former Smoker
Alcohol Consumption (If yes, drinks/day)
Uncontrollable Risk Factors
Age 55+
African American

If you have more than three of the above risk factors, print this page and see your physician or call Sacred Heart at (850) 416-1600 for a physician referral.

The more risk factors you have, the higher your chances of having a stroke. The best way to prevent a stroke is to reduce your risk factors. Your physician can help you change factors that are related to your lifestyle and your environment.


Stroke Center
Patient Testimonial
Stroke Resources
Symptoms of a Stroke

More Information
Sacred Heart Regional Stroke Center is dedicated to saving lives after a stroke occurs and minimizing disability related to stroke. Moreover, the Regional Stroke Center is committed to helping prevent stroke by creating awareness of stroke and its risk factors. You can control, treat and even eliminate some risk factors; other risk factors cannot be changed.

Call Sacred Heart at 416-2554 to get a referal.


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