To see if you might qualify for the remote patient monitoring and be enrolled into the program, please take moment to complete the questionnaire below
1. Have you been diagnosed with hypertension or diabetes
- Yes
- No
- Not sure
2. What is your year of birth?
__________________________________________________________
3. Do you have Medicare health Insurance
- Yes
- No
- Not sure
4. What is your secondary insurance ?
_______________________________________________
5. To which gender identity do you most identify?
- Male
- Female
- Prefer not to say
- Not listed __________________________