Cardiac Health Assessment – Onyx Studios Interactive

Cardiac Health Self-Assesment Tool

Final PPE Form V2 (16 March)

First Name

Last Name

Date of Birth

Date of Examination

Sex assigned at birth (F, M, or intersex)

Male

Female

How do you identify your gender? (F/M/other)

Age

Sport

Booster Date (if applicable)

Please List Any Past and Current Medical Conditions

Have You Ever Had Surgery? If Yes, Please List All Past Surgical Procedures

Medicines and Supplements: List all current prescriptions, over the counter medicines, and supplements (herbal and nutritional)

Do You Have Any Allergies?

Yes

Please list any medicinal allergies you have (if applicable)

Please list any specific food allergies (if applicable)

Please list any specific pollen allergies (if applicable)

Please list any specific stinging insect allergies (if applicable)

Over the last two weeks, how often have you been bothered by any of the following problems

	Not At All	Several Days	Over Half the Days	Nearly Every Day
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
Little Interest or Pleasure in Doing Things
Feeling Down, Depressed or Helpless

Do You have any concerns that you would like to discuss with your provider?

Yes

Has a doctor ever denied or restricted your participation in sports for any reason?

Yes

Do you have any ongoing medical conditions or recent illness? If so, please identify below

Have you ever passed out or nearly passed out during or after exercise? (Please watch the video below)

Yes

Onyx Studios Interactive

Your digital agency for all web solutions

Portfolio

VIDEOS, WEBSITES, VISUAL IDENTITIES, PRODUCT DESIGNING, COPYWRITING
A little taste of what we do!

Social Media

Logo Design

Website Design

Real Estate

Main salespage for a real estate project in the south of France.
Live Website

Artisan Interiors

Homepage template I developed for an Interior Design concept.
Live Website

Service Agency Homepage

This is a template I designed for a service agency.

Lightning Design Formula

Salespage for online web design training.
Live Website

Consulting Homepage

Personal consultant homepage design.
Live Website

Daily Wellness

Goal of this project was to demonstrate how to build a mobile responsive website for a health and wellness company.
Live Website

Video Marketing

https://youtu.be/3TCdBbhhQyU

ZoneFive Promotional Video

Promotional video I create for a mobile app designed to increase team productivity.

http://onyxstudiosinteractive.com/wp-content/uploads/2020/10/Artist_Love_by_Nejda_Launching_Store.mp4

Ecommerce Video Ad

Promotional video for an ecommerce store.

https://www.youtube.com/watch?v=NZXznLFNFAQ&feature=emb_title

Real Estate Video Ad

Video ad for a home real estate marketing campaign.

Videos

https://youtu.be/3TCdBbhhQyU

ZoneFive

Promotional video I create for a mobile app designed to increase team productivity.

Onyx Studios Interactive

Your digital agency for all web solutions

Portfolio

VIDEOS, WEBSITES, VISUAL IDENTITIES, PRODUCT DESIGNING, COPYWRITING
A little taste of what we do!

Social Media

Logo Design

Website Design

Real Estate

Main salespage for a real estate project in the south of France.
Live Website

Artisan Interiors

Homepage template I developed for an Interior Design concept.
Live Website

Service Agency Homepage

This is a template I designed for a service agency.

Lightning Design Formula

Salespage for online web design training.
Live Website

Consulting Homepage

Personal consultant homepage design.
Live Website

Daily Wellness

Goal of this project was to demonstrate how to build a mobile responsive website for a health and wellness company.
Live Website

Video Marketing

https://youtu.be/3TCdBbhhQyU

ZoneFive Promotional Video

Promotional video I create for a mobile app designed to increase team productivity.

http://onyxstudiosinteractive.com/wp-content/uploads/2020/10/Artist_Love_by_Nejda_Launching_Store.mp4

Ecommerce Video Ad

Promotional video for an ecommerce store.

https://www.youtube.com/watch?v=NZXznLFNFAQ&feature=emb_title

Real Estate Video Ad

Video ad for a home real estate marketing campaign.

Videos

https://youtu.be/3TCdBbhhQyU

ZoneFive

Promotional video I create for a mobile app designed to increase team productivity.

Have you ever had discomfort pain tightness or pressure in your chest during exercise? (Please watch the video below)

Yes

Onyx Studios Interactive

Your digital agency for all web solutions

Portfolio

VIDEOS, WEBSITES, VISUAL IDENTITIES, PRODUCT DESIGNING, COPYWRITING
A little taste of what we do!

Social Media

Logo Design

Website Design

Real Estate

Main salespage for a real estate project in the south of France.
Live Website

Artisan Interiors

Homepage template I developed for an Interior Design concept.
Live Website

Service Agency Homepage

This is a template I designed for a service agency.

Lightning Design Formula

Salespage for online web design training.
Live Website

Consulting Homepage

Personal consultant homepage design.
Live Website

Daily Wellness

Goal of this project was to demonstrate how to build a mobile responsive website for a health and wellness company.
Live Website

Video Marketing

https://youtu.be/3TCdBbhhQyU

ZoneFive Promotional Video

Promotional video I create for a mobile app designed to increase team productivity.

http://onyxstudiosinteractive.com/wp-content/uploads/2020/10/Artist_Love_by_Nejda_Launching_Store.mp4

Ecommerce Video Ad

Promotional video for an ecommerce store.

https://www.youtube.com/watch?v=NZXznLFNFAQ&feature=emb_title

Real Estate Video Ad

Video ad for a home real estate marketing campaign.

Videos

https://youtu.be/3TCdBbhhQyU

ZoneFive

Promotional video I create for a mobile app designed to increase team productivity.

Onyx Studios Interactive

Your digital agency for all web solutions

Portfolio

VIDEOS, WEBSITES, VISUAL IDENTITIES, PRODUCT DESIGNING, COPYWRITING
A little taste of what we do!

Social Media

Logo Design

Website Design

Real Estate

Main salespage for a real estate project in the south of France.
Live Website

Artisan Interiors

Homepage template I developed for an Interior Design concept.
Live Website

Service Agency Homepage

This is a template I designed for a service agency.

Lightning Design Formula

Salespage for online web design training.
Live Website

Consulting Homepage

Personal consultant homepage design.
Live Website

Daily Wellness

Goal of this project was to demonstrate how to build a mobile responsive website for a health and wellness company.
Live Website

Video Marketing

https://youtu.be/3TCdBbhhQyU

ZoneFive Promotional Video

Promotional video I create for a mobile app designed to increase team productivity.

http://onyxstudiosinteractive.com/wp-content/uploads/2020/10/Artist_Love_by_Nejda_Launching_Store.mp4

Ecommerce Video Ad

Promotional video for an ecommerce store.

https://www.youtube.com/watch?v=NZXznLFNFAQ&feature=emb_title

Real Estate Video Ad

Video ad for a home real estate marketing campaign.

Videos

https://youtu.be/3TCdBbhhQyU

ZoneFive

Promotional video I create for a mobile app designed to increase team productivity.

Does your heart ever race flutter in your chest or skip irregular beats during exercise? (Please watch the video below)

Yes

Onyx Studios Interactive

Your digital agency for all web solutions

Portfolio

VIDEOS, WEBSITES, VISUAL IDENTITIES, PRODUCT DESIGNING, COPYWRITING
A little taste of what we do!

Social Media

Logo Design

Website Design

Real Estate

Main salespage for a real estate project in the south of France.
Live Website

Artisan Interiors

Homepage template I developed for an Interior Design concept.
Live Website

Service Agency Homepage

This is a template I designed for a service agency.

Lightning Design Formula

Salespage for online web design training.
Live Website

Consulting Homepage

Personal consultant homepage design.
Live Website

Daily Wellness

Goal of this project was to demonstrate how to build a mobile responsive website for a health and wellness company.
Live Website

Video Marketing

https://youtu.be/3TCdBbhhQyU

ZoneFive Promotional Video

Promotional video I create for a mobile app designed to increase team productivity.

http://onyxstudiosinteractive.com/wp-content/uploads/2020/10/Artist_Love_by_Nejda_Launching_Store.mp4

Ecommerce Video Ad

Promotional video for an ecommerce store.

https://www.youtube.com/watch?v=NZXznLFNFAQ&feature=emb_title

Real Estate Video Ad

Video ad for a home real estate marketing campaign.

Videos

https://youtu.be/3TCdBbhhQyU

ZoneFive

Promotional video I create for a mobile app designed to increase team productivity.

Onyx Studios Interactive

Your digital agency for all web solutions

Portfolio

VIDEOS, WEBSITES, VISUAL IDENTITIES, PRODUCT DESIGNING, COPYWRITING
A little taste of what we do!

Social Media

Logo Design

Website Design

Real Estate

Main salespage for a real estate project in the south of France.
Live Website

Artisan Interiors

Homepage template I developed for an Interior Design concept.
Live Website

Service Agency Homepage

This is a template I designed for a service agency.

Lightning Design Formula

Salespage for online web design training.
Live Website

Consulting Homepage

Personal consultant homepage design.
Live Website

Daily Wellness

Goal of this project was to demonstrate how to build a mobile responsive website for a health and wellness company.
Live Website

Video Marketing

https://youtu.be/3TCdBbhhQyU

ZoneFive Promotional Video

Promotional video I create for a mobile app designed to increase team productivity.

http://onyxstudiosinteractive.com/wp-content/uploads/2020/10/Artist_Love_by_Nejda_Launching_Store.mp4

Ecommerce Video Ad

Promotional video for an ecommerce store.

https://www.youtube.com/watch?v=NZXznLFNFAQ&feature=emb_title

Real Estate Video Ad

Video ad for a home real estate marketing campaign.

Videos

https://youtu.be/3TCdBbhhQyU

ZoneFive

Promotional video I create for a mobile app designed to increase team productivity.

Has a doctor ever told you that you have any heart problems?

Yes

Has a doctor ever requested a test for your heart for example electrocardiography (ECG) or echocardiography?

Yes

Do you get light-headed or feel shorter of breath than your friends during exercise? (Please watch the video below)

Yes

Onyx Studios Interactive

Your digital agency for all web solutions

Portfolio

VIDEOS, WEBSITES, VISUAL IDENTITIES, PRODUCT DESIGNING, COPYWRITING
A little taste of what we do!

Social Media

Logo Design

Website Design

Real Estate

Main salespage for a real estate project in the south of France.
Live Website

Artisan Interiors

Homepage template I developed for an Interior Design concept.
Live Website

Service Agency Homepage

This is a template I designed for a service agency.

Lightning Design Formula

Salespage for online web design training.
Live Website

Consulting Homepage

Personal consultant homepage design.
Live Website

Daily Wellness

Goal of this project was to demonstrate how to build a mobile responsive website for a health and wellness company.
Live Website

Video Marketing

https://youtu.be/3TCdBbhhQyU

ZoneFive Promotional Video

Promotional video I create for a mobile app designed to increase team productivity.

http://onyxstudiosinteractive.com/wp-content/uploads/2020/10/Artist_Love_by_Nejda_Launching_Store.mp4

Ecommerce Video Ad

Promotional video for an ecommerce store.

https://www.youtube.com/watch?v=NZXznLFNFAQ&feature=emb_title

Real Estate Video Ad

Video ad for a home real estate marketing campaign.

Videos

https://youtu.be/3TCdBbhhQyU

ZoneFive

Promotional video I create for a mobile app designed to increase team productivity.

Onyx Studios Interactive

Your digital agency for all web solutions

Portfolio

VIDEOS, WEBSITES, VISUAL IDENTITIES, PRODUCT DESIGNING, COPYWRITING
A little taste of what we do!

Social Media

Logo Design

Website Design

Real Estate

Main salespage for a real estate project in the south of France.
Live Website

Artisan Interiors

Homepage template I developed for an Interior Design concept.
Live Website

Service Agency Homepage

This is a template I designed for a service agency.

Lightning Design Formula

Salespage for online web design training.
Live Website

Consulting Homepage

Personal consultant homepage design.
Live Website

Daily Wellness

Goal of this project was to demonstrate how to build a mobile responsive website for a health and wellness company.
Live Website

Video Marketing

https://youtu.be/3TCdBbhhQyU

ZoneFive Promotional Video

Promotional video I create for a mobile app designed to increase team productivity.

http://onyxstudiosinteractive.com/wp-content/uploads/2020/10/Artist_Love_by_Nejda_Launching_Store.mp4

Ecommerce Video Ad

Promotional video for an ecommerce store.

https://www.youtube.com/watch?v=NZXznLFNFAQ&feature=emb_title

Real Estate Video Ad

Video ad for a home real estate marketing campaign.

Videos

https://youtu.be/3TCdBbhhQyU

ZoneFive

Promotional video I create for a mobile app designed to increase team productivity.

Have you ever had a seizure?

Yes

Has any family member has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 35 years including drowning or unexplained car crash?

Yes

Does anyone in your family have a genetic heart problem or a history of heart disease? If yes please list the family member (i.e mother, father, brother, sister etc)

Has anyone in your family had a pacemaker or an implanted defibrillator before age 35?

Yes