Skip to main content
YMCA of Metropolitan Dallas
YMCA of Metropolitan Dallas
Main navigation
Join the Y
Find a fitness class
Activities at the Y
Health & Wellness
Active Older Adults
Group Exercise
Personal Training
Fitness Assessment
YMCA's Diabetes Prevention Program
Livestrong at the YMCA
FIT for Health
Blood Pressure Self-Monitoring Program
ENHANCE®FITNESS at the YMCA
Get Up and Go
Kamp K'aana
YMCA Dallas Turkey Trot
Corporate Membership
Active Older Adults
Group Exercise
Personal Training
Fitness Assessment
YMCA's Diabetes Prevention Program
Livestrong at the YMCA
FIT for Health
Blood Pressure Self-Monitoring Program
ENHANCE®FITNESS at the YMCA
Get Up and Go
Kamp K'aana
YMCA Dallas Turkey Trot
Corporate Membership
Swim, Sports, Play
Swimming
Youth Sports
For Adaptive & Special Needs
Adult Sports
Coaching
eSports
Swimming
Youth Sports
For Adaptive & Special Needs
Adult Sports
Coaching
eSports
Activities
Afterschool
Preschool
Holiday Camp
Camp
Adventure Guides
Teens
Play N Learn
Mobile Y
Afterschool
Preschool
Holiday Camp
Camp
Adventure Guides
Teens
Play N Learn
Mobile Y
Community Outreach
Current Capital Projects
Know Before You Go
Safety Around Water
Military Outreach
Big Brothers Big Sisters
Training & Certification
Child Safety
Communities We Serve
Summer Learning Academy
YMCA College Scholarship
YMCA Day of Giving
Volunteerism & Giving
Current Capital Projects
Know Before You Go
Safety Around Water
Military Outreach
Big Brothers Big Sisters
Training & Certification
Child Safety
Communities We Serve
Summer Learning Academy
YMCA College Scholarship
YMCA Day of Giving
Volunteerism & Giving
Find a location
Give to the Y
Top right menu mobile
About the Y
Blog
News & Media
Contact Us
YMCA Policies
User account menu
Account
My Account
Sign Out
Sign In
YMCA of Metropolitan Dallas
Visit YMCA of Metropolitan Dallas
Top right menu
About the Y
Blog
News & Media
Contact Us
YMCA Policies
User account menu
Account
My Account
Sign Out
Sign In
Main navigation
Join the Y
Find a fitness class
Activities at the Y
Health & Wellness
Active Older Adults
Group Exercise
Personal Training
Fitness Assessment
YMCA's Diabetes Prevention Program
Livestrong at the YMCA
FIT for Health
Blood Pressure Self-Monitoring Program
ENHANCE®FITNESS at the YMCA
Get Up and Go
Kamp K'aana
YMCA Dallas Turkey Trot
Corporate Membership
Active Older Adults
Group Exercise
Personal Training
Fitness Assessment
YMCA's Diabetes Prevention Program
Livestrong at the YMCA
FIT for Health
Blood Pressure Self-Monitoring Program
ENHANCE®FITNESS at the YMCA
Get Up and Go
Kamp K'aana
YMCA Dallas Turkey Trot
Corporate Membership
Swim, Sports, Play
Swimming
Youth Sports
For Adaptive & Special Needs
Adult Sports
Coaching
eSports
Swimming
Youth Sports
For Adaptive & Special Needs
Adult Sports
Coaching
eSports
Activities
Afterschool
Preschool
Holiday Camp
Camp
Adventure Guides
Teens
Play N Learn
Mobile Y
Afterschool
Preschool
Holiday Camp
Camp
Adventure Guides
Teens
Play N Learn
Mobile Y
Community Outreach
Current Capital Projects
Know Before You Go
Safety Around Water
Military Outreach
Big Brothers Big Sisters
Training & Certification
Child Safety
Communities We Serve
Summer Learning Academy
YMCA College Scholarship
YMCA Day of Giving
Volunteerism & Giving
Current Capital Projects
Know Before You Go
Safety Around Water
Military Outreach
Big Brothers Big Sisters
Training & Certification
Child Safety
Communities We Serve
Summer Learning Academy
YMCA College Scholarship
YMCA Day of Giving
Volunteerism & Giving
Find a location
Give to the Y
Blood Pressure Self-Monitoring
Name
First/Primer
Last/Último
Date of Birth/Fecha de Nacimiento
Gender/Sexo
- None -
Male/Masculino
Female/Femenino
Prefer not to answer/Prefiero no responder
Phone Number/Número de teléfono
Email Address/Correo Electrónico
Address
Address/Dirección
City/Ciudad
Zip/Postal Code/Código postal
Are you a member of the YMCA? / ¿Eres miembro de la YCMA?
- None -
Member
Non-Member
How did you hear about the program? / ¿Cómo se enteró de este programa?
Doctor/Médico
Chiropractor/Quiropráctico
Nurse/Enfermero
Practice Manager or Office Manager/Gerente de práctica o gerente de oficina
Pharmacist/Farmacéutico
Screening/Testing Event or Health Fair/Prueba de Detección
Family/Friend or Word of Mouth/Familiar / Amigo
Employer/Empleador
Insurance Company/Compañía de Seguro
Media/Medios (TV, web, radio, print, etc.)
Staff Member/Miembro del equipo
Other/Otro
Participant Qualification Criteria:
Has patient ever been diagnosed with high blood pressure/hypertension?
- None -
Yes
No
Is patient currently taking prescription medication to control or manage high blood pressure? / ¿El paciente está tomando medicamentos recetados para controlar la presión arterial alta?
- None -
Yes
No
Has patient had a recent cardiac event within the last year? / ¿El paciente ha tenido un evento cardíaco reciente en el último año?
- None -
Yes
No
Does patient have atrial fibrillation or other arrhythmias? / ¿Tiene el paciente fibrilación auricular u otras arritmias?
- None -
Yes
No
Is patient at risk for lymphedema? / ¿Está el paciente en riesgo de linfedema?
- None -
Yes
No
If you answered YES to questions 1 or 2
AND
NO to questions 3-5, then your patient may qualify for this program to help manage hypertension.
Si respondió SÍ a las preguntas 1 o 2 Y no a las preguntas 4 a 6, entonces su paciente puede calificar para este programa para ayudar a controlar la hipertensión.