Cardiac Health Questionnaire

The American Heart Association recommends completing a cardiac history as the first step to determine the need for further cardiac testing in seemingly healthy young adults.  Unfornuately, many young adults who die from hidden heart conditions die without prior symptoms.  We recommend that all young adults should receive an ECG/EKG periodically, but we also provide this questionnaire.

  • Heart Checkup at Annual Physicial: Download the Pre-Participation Physical Evaluation (4th edition) with ICD 10 diagnostic codes.  Your child’s EGK test may be covered by your insurance plan. Complete this form and ask your physician to help determine if an EKG test for your child might be covered by your health plan.
  • Read our recommendations to parents and students entering high school.
  • Adding ECG/EKG’s to Young Adult Exams for Primary Care MDs
  • Protecting Your College Athlete’s Heart

Please reach out to us with any questions regarding EKG screening.  There are many informative medical journal and mainstream media articles on this topic on our web site. You may also download our summer outreach letter here.