NOAH Three Month Check. Change. Control.® Challenge 2023

NOAH Three Month Check. Change. Control.® Challenge
Check. Change. Control.® (CCC) is a three month evidence-based blood pressure prevention and management program that empowers participants to take charge of their cardiovascular health by self-monitoring their blood pressure. The program provides participants knowledge to improve their blood pressure numbers by implementing behavior changes such as moving more, eating heathy and improving mental well-being. For any questions pertaining to this questionnaire, or the CCC program, please contact phoenixccc@heart.org.
Full Name*

First NameLast Name
Select your Division/Team from the following list:*
You chose other above, please indicate your answer here:
NOAH Email Address*
example@example.com
I know what my blood pressure readings typically are: (Choose 1 answer only)*

TrueFalse
Blood pressure readings considered to be in the ‘normal’ blood pressure category are: (Choose 1 answer only)*

130-139/80-89120/80Less than 120/less than 80140 or higher/90 or higherI don’t know
Select all the items listed below that increase your risk of developing high blood pressure: (May select multiple)*

High sodium dietLack of physical activityUncontrolled stressMaintaining a healthy weight
In general, how would you rate your current overall health? (Choose 1 answer only)*

ExcellentGoodFairPoor
Please acknowledge and accept the following statement:

By submitting this form I agree to participate in the 3-Month Check. Change. Control. Program with the American Heart Association (AHA). As a participant, I will receive emails and communications as part of the program.
Please acknowledge and accept the following statement:

By submitting this form I agree that AHA may share my name with NOAH, so that I may be eligible for an incentive.
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