Consent Form

Thank you for starting your Heart Stress Risk Profile. First we need your consent to collect your information.

HealthStressRisk Inc. (the “company”) is pleased that you are taking the next step to investigate the relationship between YOUR stresses and YOUR heart risks. Information on how our website operates including the generation of your Heart Stress Risk Profile (“Risk Profile”) through your use of the self-assessment form is found below.

Please note that your use of the website and Risk Profile is subject to the company’s Terms of Use Agreement and its Privacy Policy.

CAUTION: Please note that the Risk Profile and all other information provided on the company’s website are provided for information purposes only. Nothing on or available through the website constitutes health care in any way, and is not a substitute for medical advice in diagnosing or treating any stress or heart problem or other health condition you may have. Always consult with your medical doctor or health care provider about any health care concerns you may have.

Procedure: For this self-assessment to be most helpful to you, answer the questions as directly and as honestly as you can. We will not disclose your individual answers. The value of the Risk Profile you may receive depends directly on the accuracy of your self-report.

Allow 5 – 15 minutes to answer the questions on the self-assessment form. If you do not have the time now, please come back to complete the questions when you have the time as there is no way of saving your work part way through your assessment.

After you have completed the questionnaire, you will submit the form and be asked to provide the email address you would like the results sent to. Finish all the questions, submit your answers, and then go to your email account. You will be asked to confirm your email address by responding to an email from Heart Stress Risk.com. Your Risk Profile is emailed to you once you have confirmed.  Your answers will be compiled into your personal Risk Profile.

Benefits:  The Risk Profile provides you with information on whether you have a Low, Moderate, or High Risk for seven different stressors that increase heart attack risk. After you have received your Risk Profile, read through it carefully and take the time to consider what it suggests about your greatest risks. The Risk Profile will focus you on the areas that you may need to consider making changes to. It will also give you suggestions on ways to begin to make those changes.

HealthStressRisk Inc. encourages you to bring your Risk Profile to your physician, cardiologist, and health team for their advice on how to reduce stress. Your Risk Profile may provide you and your doctors with important information you may not get any other way. Your Risk Profile may provide a snapshot of the stress challenges you may currently face as well as your map for starting change now.

Risks: There are no known risks in answering questions about your stress and life experiences. However, if you find that you do have an unexpected or unusual reaction to completing these questions, contact your doctor or health care provider immediately.

Limitations: The Risk Profile is NOT a diagnostic test OR a psychological evaluation and does not constitute medical advice or health care. It is a self-report of your stress experiences that can be compared with similar answers obtained in large population studies that have followed people for more than ten years. Across that time the increased risks for having a heart attack begin to emerge. If you have some ‘High Risk’ results, it may mean that across 10+ years you will have a higher risk of having a heart attack. It DOES NOT NECESSARILY MEAN that you are in immediate danger.

Second, be aware that this self-assessment does not identify ALL your heart risks. For example, traditional medical risks are still best evaluated by your physician and medical tests. This self-assessment DOES NOT REPLACE the treatment plan and health care that your physician, cardiologist, and cardiac rehabilitation team may be already providing you. It may be a useful source of supplemental information to understand how stress risks may complicate your recovery.

In summary, this Risk Profile may provide you with a way of understanding what your biggest STRESS RISKS are. Accurate assessment may open the door to a better understanding of what you need to do for yourself, to reduce your stress risks. When you share this information with your treatment team, a better overall plan may be formulated for you.

Voluntary Participation: Your participation in this self-assessment is completely voluntary. You may refrain from answering any questions you are not comfortable with. You can also decide to stop participating in the self-assessment at any time, for any reason. Your decision to stop your self-assessment, or to refuse to answer particular questions, will not affect your ability to continue to attend the site and learn more about stress risks from the News blogs. If you withdraw from the assessment before you submit your data, none of your individual data will be retained in our database.

Email Communications: After you have submitted your answers, you will receive your Risk Profile. As well, you will receive follow-up emails that further explain the seven areas of stress and ways of using your results to make changes in your life. You will not receive any spam from us, nor will we ever release your email address to others. You are free to discontinue receiving these emails at any time: just remove yourself from the email list by responding to the link at the bottom of the emails. While you are free to withdraw after you have submitted your answers, your answers cannot be removed from our database.

Anonymous database: All answers provided by persons completing the Risk Profile will be stored for ongoing investigation of stress and heart risks. No personal identifiers are included with your answers, for example your name or your email address. The data that will be used for ongoing investigations is “anonymous” because reading the answers provided to the demographic, medical, psychological and lifestyle questions cannot lead back to locate any individual participant.

Ongoing Investigations:  The information you have provided will be stored in our database, and will be used to continue to improve the value of the information provided to visitors of the website, as well as for ongoing investigation of how stress factors relate to each other.  All data provided can be used in studies by HeartStressRisk Inc. and researchers on the company’s Research Advisory Board. No individual will ever be identified in any reports or publications developed from the website.

Site Security: Our database is kept confidential by encrypting all data and storing information in password protected files on our website servers. This information will not be in “the cloud” of the internet, and will not be available for unauthorized access. Our website and storage procedures are compliant with all security requirements for storage of health and research databases.

Participant Consent

By clicking the “I Consent” button below you are stating that you understand the above information and agree to participate. You are free to withdraw at any time. If you would like a copy of this Consent form, request that a copy be sent to you by emailing us.


If you are 19 years of age or older and you AGREE to all aspects of this website’s operation including the Terms of Use Agreement and Privacy Policy, and how the information you provide will be used, click on the “I Consent” button below.

I Consent

If you DO NOT AGREE with how the website is operated or the Terms of Use Agreement, Privacy Policy, or how the information you provide will be used, or you are under 19 years of age, click on the “I DO NOT Consent” button below.

I DO NOT Consent with completing this assessment at this time

If you DO NOT Consent at this time, you can contact us to seek clarification on matters that concern you, before you decide you can agree.