First Name
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City, State
N/A
Phone Number
N/A
Last Name
N/A
N/A
Date Quiz Taken
N/A
QUIZ SCORE:
RESULT:
Based on your answers to the questions, you are likely to be a candidate for CCM® therapy and you should follow up with your health care provider.
Print your results to discuss with your doctor
Are you still experiencing heart failure symptoms despite being on medications prescribed by your doctor for heart failure?
N/A
Has your doctor told you that you have permanent atrial fibrillation?
N/A
Do you have difficulty breathing at rest or during activity?
N/A
Have you experienced any of the following? (Multiple selection)
N/A
Do your symptoms make it hard for you to accomplish your normal daily activities?
N/A
Do you have difficulty breathing while trying to sleep and need to use pillows to get a good night’s rest?
N/A
Do you have an implanted device to treat your heart failure?
N/A
Do you know what your ejection fraction or EF is (a measurement of the heart’s pumping efficiency)?
N/A
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