Cardio Pulse (HEART HEALTH SCREENING APPOINTMENT FORM)

HEART HEALTH SCREENING

Fill out the form carefully for appointment booking.
APPOINTMENT FORM : All qualified individuals permitted to take the Cardio Pulse Test

CONSULTATION Fee : (FREE for the whole month of May 2024)
Full Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Mobile Number*
Format (9171234567) Don’t include the “0” ZERO
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
In case of emergency, contact person:

Full NameRelationshipContact Number
PREPARATIONS BEFORE THE TEST

1. Have at least 6-8 hours of sleep

2. Avoid smoking,eating, drinking (softdrinks, coffee, tea, water…etc.) & heavy workout at least 2 hours before the test.

3. Must remove all jewelries/accessories, nail polish (left index finger) coins and any metal objects on your body.

4. For women w/ menstrual period, will have to wait at least 3-4 days after their last menstruation.

Note: If you are sick,not feeling well, in pain or pregnant, you are temporarily not eligible to take the test, we might have inaccurate result. Unfortunately, if you have metal implants, pacemaker, you are not eligible to take the test.
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HEART HEALTH SCREENING