August 24, 2024
11:00am-12:30pm ET

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Phone Number

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* 5. Age

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* 6. Gender

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* 7. Race/Ethnicity (please check all that apply)

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* 8. City and State of Residence

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* 9. On a scale from 1 to 7, how knowledgeable are you about high blood pressure?

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* 10. Have you or someone in your immediate family been diagnosed with high blood pressure?

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* 11. If you have received a diagnosis, how would you rate the severity of your high blood pressure?

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* 12. Do you own a blood pressure monitor?

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* 13. Are you in need of a blood pressure monitor?

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* 14. If you are in need of a blood pressure monitor, please provide your address below.

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* 15. Would you like to join this month's healthy challenge to improve your exercise routine?

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