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Blood Pressure Self-Monitoring Interest Form
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Program Qualifications. Please select all that apply.
*
Be at least 18 years old
Be diagnosed with high blood pressure
Not have experienced a recent cardiac event
Not have atrial fibrillation or other arrhythmias
Not be at risk for lymphedema
Required
First and Last Name
*
Your answer
Street Address | City, State | ZIP
*
Your answer
Daytime Phone
*
Your answer
Email Address
Your answer
Preferred Branch
Clover YMCA
CSD Community YMCA
Baxter Close YMCA
Fort Mill YMCA at the Complex
Gregory Family YMCA
Indian Land YMCA
Charlotte Avenue YMCA
York YMCA
Virtual
Clear selection
How do you believe this program will benefit you?
Your answer
How did you hear about this program?
*
Your answer
Are you a YMCA of Upper Palmetto? (*Membership is not required_
Yes
No
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