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Mile High Vascular

PAD Screening Tool™

Venous Screening Tool

Peripheral artery disease, or PAD, means blood is not flowing properly in your legs or arms. It is common as we get older. But PAD is often missed or not talked about, especially in patients with diabetes, heart disease or chronic kidney disease. Many people don’t even know they have it. To find out, it’s important to know your risk factors and look out for signs and symptoms.

By using our PAD Screening Tool below and submitting it to our clinical experts for review, we may contact you to schedule an in-office ultrasound or arterial evaluation. Early diagnosis and treatment of PAD can help prevent irreversible damage to your legs, and the development of wounds or possible amputation.

Simply fill out the short questionnaire below and click the “Send” button to submit your information for further review. A member of our team will reach out to you.

Name

User Email

Phone Number:

1. Are you 65 or older?

2. Do you or have you ever smoked?

3. Are you Black?

4. Do you have diabetes, high cholesterol, chronic kidney disease, or high blood pressure, obesity?






5. Has anyone in your family had PAD?

6. Have you ever had a heart attack, stroke or a procedure to open an artery supplying your heart or legs?





7. How active are you overall?



If you are not as active as you once were, why is this the case?

8. Do you ever have pain, heaviness or aching in your legs when exercising or walking?

If so, what were you doing at the time?

9. Do these feelings go away when you stop activity or rest?




10. Is your walking slower compared with others?

11. Do you ever have pain in your hips or buttocks?

12. Do you sometimes feel numbness in your feet or legs?

13. When you look at your legs or feet, do you notice any: