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