Please copy and paste the questions below and e-mail your answers back to us at orders@mypharmacy.co.uk
This questionnaire will calculate your risk of having a heart attack or angina in the next ten years. You can use it to guide you to the health decisions you need to make to minimise that risk, and find if Zocor Heart-Pro is suitable for you to take.
Your Score |
|
Age (For men) |
|
| Ethnic origin White (score 0) ; South Asian (Pakistan, India, Bangladesh, Sri Lanka) (score 3): Other ethnic group (score 1) |
|
| My immediate family has a history of heart disease Family counts as a father or brother under 55 and/or mother or sister under 65 Yes (score 2): No (score 0) |
|
| I exercise regularly for at least 30 minutes twice weekly Yes (score 0): No (score 1) |
|
| I am a current smoker or have quit within the last year Yes (score 2): No (score 0) |
|
| I am overweight This is either having a BMI over 25 or a waist size over 40"/102cm (man); or 35"/88cm (woman) See the box below if you need help to calculate your BMI Yes (score 1): No (score 0) |
|
| Your Total Score Add up your individual scores to give a total score |
The BBC web site has a very good calculator to work out your BMI, and if you are overweight. Click here to calculate in Feet and Pounds or Centimetres and Kilograms
*Please note that Zocor Heart-Pro is not licensed for you to use if you are in these age groups
Your Answer |
|
| Please confirm that you have read the product information for Zocor Heart-Pro, and that you are using it within these guidelines. | Yes or No |
| Your Name? | |
| Name of the person taking Zocor Heart-Pro? | |
| Their date of birth? | |
| Have they ever had a heart or circulation problem? e.g. heart attack; angina; stroke; poor blood flow to the legs resulting in muscle pain when you walk. Are you are being treated for high blood pressure? Have you had any recent heart or chest pain brought on by exercise? |
|
| Do they have any tendency towards liver problems? e.g. liver disease or history of abnormal tests. Is your average daily intake of alcohol is greater than 4 units for men or 3 units for women? (1 unit = ½ pint of beer, 1 small glass of wine, or 1 pub measure of spirits) |
|
| Do they have any tendency to high cholesterol levels? Does your family suffer from high cholesterol (familial hyperlipidaemia)? Have you ever been prescribed cholesterol-lowering medication? |
|
| Have they had any other medical conditions now, or in the past? e.g. diabetes, underactive thyroid, kidney problems, muscle disorders in the family, porphyria (a very rare disorder that runs in families), or any other medical problems not listed above? If so please give details. |
|
| What other medicines, herbal remedies, vitamins or supplements are being taken? |
This is the end of the questions we need you to answer and send back to us.
Why do I need to fill in this form?
It is a legal requirement that Pharmacy Medicines are sold under the supervision of a pharmacist, who must ensure that the medicine is being used properly. The questions that we ask will give us the background we need to determine this, so please answer them fully because the pharmacist will not authorise the sale until he is happy with the details. It is important to check the box confirming that you have read the information that we give on our web site to confirm that you are using the medicine accoring to the guidance given.
Zocor Heart-Pro needs even more information to be checked, and a risk assessment carried out.
What do you do with the answers on the form?
We store all this information on a secure database, and you will not need to send it again if you order the same product in the future, however we do need new information if you are using a new product, or if your details have changed. We are registered for the storage of this data under the Data Protection Act, and can not delete it.
Your Score |
|
0-3 |
Low risk of heart attack. You do not need to take Zocor Heart-Pro. Keep your risk low by continuing to concentrate on leading a healthy lefestyle |
4-7 |
Moderate risk of heart attack. Zocor Heart-Pro could significantly reduce your risk of having a heart attack. Look at all the other things that you can also do to bring down your risks, such as taking more exercise, giving up smoking and loosing weight |
8+ |
Higher risk of heart attack. You should have a risk assessment done by your doctor, who may then recommend Zocor Heart-Pro for you. You can then buy it from us. Look at all the other things that you can also do to bring down your risks, such as taking more exercise, giving up smoking and loosing weight |
Buying Zocor Heart-Pro is a major decision to make, as you need to take it every day for years to get the maximum health benefit.
If you wish to buy Zocor Heart-Pro from us again, you will not need to fill-in these details every time, as we will keep your details on record.
The easiest way to buy Zocor Heart-Pro from us is on a regular order, where we send you 3 boxes every 12 weeks, so that you always have a supply on hand without having to reorder when you are getting low. We will contact you to ask you for your credit card details to keep on record, so that we don't have to bother you every time. You can cancel this at any time.