P.A.D. SCREENING | Cardiovascular Specialists of York

Do you experience discomfort while walking?

Yes No

Have you experienced hair loss below the knee over time?

Yes No

While resting do you find yourself sitting up to dangle your legs off the edge of the couch or bed to relieve discomfort?

Yes No

Do you experience foot or toe pain that often disturbs your sleep?

Yes No

Are your toes or feet pale, discolored, or bluish?

Yes No

Do you have skin wounds or ulcers on your feet or toes?

Yes No

Has your doctor ever told you that you have Diminished or Absent Pedal (foot) Pulse?

Yes No

Have you ever had vascular surgery on your leg(s)?

Yes No

Do you have an infection of the leg(s) or feet that may be gangrenous (black skin tissue)?

Yes No

Are you a diabetic?

Yes No