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Stroke Education Form
Stroke Awareness
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Age
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40
41-60
61-80
81
Have you or anyone you know suffered a stroke?
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Yes
No
What is the newest acronym for stroke?
*
FAST
BEFAST
PASS
STEMI
What are risk factors for stroke? Check all that apply.
*
Hypertension
Smoking
High cholesterol
Diabetes
A-fib
WHAT IS THE FIRST THING YOU SHOULD DO IF YOU OR ANYONE AROUND YOU DEVELOPS STROKE SYMPTOMS?
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Call my doctor
Call 911
Drive to the hospital
Wait and see if it gets better
Have you received stroke education from Broward Health today?
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