Peripheral Artery Disease Risk Assessment

Tell us about yourself! Select the answers that best describe you so we can provide an assessment.

How old are you?(Required)

Less than 50 years old

50 to 84 years old

85 years old or older

Do you smoke or have you smoked?

No

Yes

Tell us about your medical history. For each of the following questions, please select the answer that best describes your situation.

Have you been diagnosed with diabetes?

Yes

No

Have you been diagnosed with chronic kidney disease?

Yes

No

Have you been diagnosed with high blood pressure?

Yes

No

Have you been diagnosed with high cholesterol?

Yes

No

Name(Required)

First Last

Phone(Required)

Email(Required)

What's The Best Time For Your Vascular Evaluation? *(Required)

Associations & Organizations