National Screening For Vascular Disease

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Are You at Risk for Peripheral Arterial Disease (PAD)?

Your answers to these questions will help you know.

DO YOU HAVE:

Cardiovascular (heart) problems such as
high blood pressure, heart attack, stroke?
Yes No
Diabetes? Yes No
A family history of diabetes or cardiovascular problems
(immediate family such as parent, sister, brother)?
Yes No
Aching, cramping or pain in your legs when you walk or exercise,
but then the pain goes away when you rest?
Yes No
Pain in your toes or feet at night? Yes No
Any ulcers or sores on your feet or legs that are slow in healing? Yes No
An inactive lifestyle? Yes No
Do you smoke? Yes No
Have you ever smoked? Yes No
 

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The higher your score, the more important it is for you to see your doctor. You and your doctor may wish to discuss your responses to this questionnaire.

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