Your Gender:

MALE FEMALE

Your Age:

25-35 36-45 46-55 56-75

Do You Smoke / have smoked till 1 year back:

Yes No

Family History(blood relative)of heart attack:

Yes No

Existing, Recent past heart disease, Stroke :

Yes No

Diabetes :

Yes No

No Diabetes but Fasting Blood sugar :

more than 100mg%

Your Waist Size:

Male: <38” >38”

Female:<35” >35”

What is your Systolic (upper BP) :

<130/80 >130/85

Are you taking Medicine for high BP :

Yes No

What is your Total Cholesterol :

<180 >180

What is your LDL :

<100 >100

What is your HDL :

>45 <40

What is your Triglycerides :

>150 <150