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Patient
Questionnaire

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Peripheral Arterial Disease Questionnaire

Answers to these questions will determine if you are at risk for PAD. Your answers to these questions can be used in discussions with your doctor about PAD.

1. Are you 65 years or older?
Yes
No
2. Do you have foot, calf, buttock, hip or thigh discomfort (aching, fatigue, tingling, cramping or pain) when your walk, which is relieved by rest?
Yes
No
3. If yes to #2, does this pain go away within 10-minutes after stopping?
Yes
No
N/A
4. Do you experience any pain at rest in your lower leg(s) or feet?
Yes
No
5. Are your toes or feet pale, discolored, or bluish?
Yes
No
6. Do you have an infection, skin wound or ulcer on your feet or toes that are slow to heal (8-12 weeks)?
Yes
No
7. Do you have high cholesterol or other blood lipid problems or take medication to lower your cholesterol level?
Yes
No
8. Do you have high blood pressure or take medication for high blood pressure?
Yes
No
9. Do you have diabetes?
Yes
No
10. Do you have history of chronic kidney disease?
Yes
No
11. Do you have a history of smoking?
Yes
No
12. Have you had a stroke or mini-stroke (TIA)?
Yes
No
13. Do you have coronary artery disease (blockage in the heart)?
Yes
No

Managing Peripheral Arterial Disease (PAD) is challenging due to its often asymptomatic nature, the need for early detection in high-risk populations, and the necessity of comprehensive care that addresses both lifestyle modifications and medical interventions.

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The “Silent Killer” ~30% of Americans Don’t Know They Have.

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Peripheral Arterial Disease (PAD) significantly increases the risk of heart attack and stroke. often going undetected because it progresses with minimal symptoms, earning it the label of a "silent killer."

The Impact and Progression of Peripheral Arterial Disease

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Learn more about how QuantaFlo can improve outcome for your PAD patients.
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