Yes No

2. Have you ever had a stroke?

Yes No

3. Have you ever had a transient ischemic attack, also known as a mini-stroke or TIA?

Yes No

4. Is your blood pressure higher than 140/90 mm Hg?

Yes No

5. Do you have diabetes?

Yes No

6. Do you have history of atrial fibrillation (a rapid, irregular heartbeat)?

Yes No

7. Do you smoke?

Yes No

8. Do you drink more than what is recommended? (For women, more than 2 drinks a day most days, up to a weekly maximum of 10 drinks; for men, more than 3 drinks a day most days, up to a weekly maximum of 15 drinks.)

Yes No

9. Has any of your immediate family ever had a stroke?

Yes No

10. Are you overweight?

Yes No

11. Do you exercise less than 30 minutes per day, 5 days per week?

Yes No

12. Are you of First Nations, African, or South Asian descent?

Yes No