Entresto – All Gold Group Demos

Name*

First Last

Mobile Number

How long have you had Congestive Heart Failure (CHF)?*

Were you recently discharged from the hospital?*

How long have you been taking ENTRESTO*

Are you taking an ACE Inhibitor?*

How confident are you that you will be successful in following a CHF care plan?*

What type of support would you want to receive?*

(Please check all that apply)

Do you want to include a caregiver to support you in your treatment plan?*

Caregiver Information

Name*

First Last

Mobile Number*