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Present this completed survey to your physician/nurse practitioner/physician assistant.

Enhanced external counterpulsation therapy is a non-invasive treatment for angina and heart failure that is available through this office. Answer the questions below to see if EECP® therapy might be right for you.

Check off the symptoms that affect you:

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1. Do you ever get symptoms like the ones you circled above when walking 1 or 2 blocks on level ground or climbing one flight of stairs at a normal pace? Yes No 2. Do you feel that these symptoms limit your activities of daily living such as household chores, shopping or leisure? Yes No 3. Do you ever get these symptoms at rest, after eating, or just watching television? Yes No 4. Do you ever awaken at night with these symptoms? Yes No 5. Have you decreased your activity in the past 6 months due to these symptoms? Yes No 6. Do you avoid activity because you might get these symptoms? Yes No 7. Do you take nitroglycerin tablets before certain activities to prevent these symptoms? Yes No 8. Are you dissatisfied with your current quality of life because of lack of energy, symptoms, or inability to engage in your normal activities of daily living? Yes No 9. Have you ever had bypass surgery, angioplasty or stents? Yes No 10. Do you take the medication Ranexa® or ranolazine? Yes No Print this survey and present to your physician/nurse practitioner/physician assistant >>

If you answered “Yes” to any of the above questions, you may be a candidate for EECP therapy.

To locate a treatment center near you, please click here > Locate EECP Treatment Centers