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STROKE PREVENTION CLINIC REFERRAL FORM Telephone: (905)5768711 ext. 3792Fax: (905)7217797Event Date: Presenting Symptoms:Investigations for Diagnosis:(Check all that apply) Speech Disturbance Expressive/Receptive/Global
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To fill out a stroke prevention clinic, follow these steps:
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Contact the stroke prevention clinic and book an appointment.
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Gather all the necessary medical records and documents, such as your medical history, current medications, and any previous tests or scans related to stroke prevention.
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Arrive at the clinic on the scheduled date and time.
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Complete any required paperwork or forms given by the clinic.
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Provide the clinic with accurate and detailed information about your medical history, lifestyle, and any existing risk factors for stroke.
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Undergo various medical tests and screenings as determined by the healthcare professionals at the clinic.
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Follow any additional instructions or recommendations provided by the clinic regarding lifestyle changes, medication, or further treatments to prevent stroke.
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It is essential to closely follow the instructions and advice given by the stroke prevention clinic to reduce your risk of stroke.
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Who needs stroke prevention clinic?

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Stroke prevention clinics are suitable for individuals who fall into the following categories:
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- Individuals with a history of stroke or mini-strokes (TIA)
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- People with risk factors for stroke such as high blood pressure, high cholesterol levels, diabetes, smoking, obesity, or a sedentary lifestyle
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- Those with a family history of stroke
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- Individuals with heart disease or other cardiovascular conditions
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However, it is always recommended to consult with a healthcare professional to determine if a stroke prevention clinic is necessary for your specific circumstances.
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A stroke prevention clinic is a specialized medical facility that focuses on preventing strokes through risk assessment, lifestyle changes, and medication.
Healthcare providers, physicians, or clinics that offer stroke prevention services are required to file stroke prevention clinic reports.
To fill out a stroke prevention clinic report, healthcare providers need to document patient information, risk assessments, treatment plans, and follow-up procedures.
The purpose of a stroke prevention clinic is to identify individuals at risk of stroke, implement preventative measures, and reduce the incidence of stroke in the population.
Information such as patient demographics, medical history, risk factors, treatment plans, and outcomes must be reported on stroke prevention clinic reports.
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