1. Do you take Coumadin or warfarin every day?
YES
NO
2. Do you have one of the following conditions?
YES
NO
          Chronic atrial fibrillation
          Mechanical heart valve(s)
          Deep vein thrombosis
          Pulmonary embolism
          Primary hypercoaguable state
3. Do you generally follow your doctor's orders?
YES
NO
4. Are you physically able to perform a PT/INR self test once a week or do you have a caregiver who can help you?
YES
NO
5. Would you like the convenience of self testing at home instead of going to a lab or doctor's office?
YES
NO
6. Do you dislike getting your blood drawn?
YES
NO
7. Do you travel often and sometimes find it inconvenient to get to your doctor's office or lab for INR testing?
YES
NO