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Pregnant or trying to become pregnantBreastfeedingSuffering from kidney problems or diseaseSuffering from liver problemsTake prescribed statin every other dayHave an allergic reaction or serious side effect to statinsHave HIVSuffering from Amyotrophic Lateral Sclerosis (ALS)None apply
Smoking raises the risk of heart disease.
Yes. Smoke cigarettesYes. Use other tobacco productsNo. I quit smokingNo. I never smoked
Chest pain or shortness of breath when walking four blocksChest pain or shortness of breath when having sexUnexplained dizzinessCramping of legs with exerciseAbnormal heart beats that prevent you from exerciseNone of the above
YesNever had a problem with hypothyroidism
Drink more than one drink/day (women only)Drink more than two drinks/day (men only)More than five drinks at one time for five days in a row
Please list your drug allergies and what happens when you use that drug.
Include vitamins, herbs, and over-the-counter products, like pain relievers and sleep aids and WHY you are taking them.
In order for us to provide you with the best care, please let us know what medications you take and what conditions you have.
Seizure disorder or epilepsyGlaucoma, cataracts, or high intraocular pressureOsteoporosisHistory or currently have tuberculosis (TB)Myasthenia gravisSclerodermaCancer or history of cancerMigraine headachesNone apply
ell us about any concerns or questions you have for the medical team.
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After you submit your request, a licensed medical provider will review your information. You will be notified by email/contact number when that provider has reviewed your request and, if appropriate, made care recommendations.