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Cardiac Study
Information confidential for Bradenton Research Center only.
Who are you taking this questionnaire for?
Myself
My Relative
My Partner
Someone I care For
Someone Else
Are you/they over 45 years old?
Yes
No
Have you/they ever been diagnosed with or do you currently have diabetes?
Yes
No
Have you/they ever had a heart attack, stroke or arterial vascular disease?
Yes
No
First Name
Phone Number
Submit The Inquiry
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