Heart Failure Self-Refer Questionnaire

Questions:

  • Do you get short of breath when walking?
  • Do you sleep with more than one pillow?
  • Do you ever notice rapid or irregular heartbeat?
  • Is your ability to exercise reduced?
  • Do you have a persistent wet cough?
  • Have you noticed swelling in your ankles or other parts of body?
  • Do you notice having to urinate more at night?
  • Have you been gaining weight?
  • Do you have decreased concentration or alertness?

If you answered “yes” to any of these questions, please contact our Nurse Coordinator at:

Puyallup: 253-697-2539 or Tacoma: 253-301-5370