Risk Assessment

Are you or someone you love at an increased risk for disease of arteries, veins, lymph vessels, and other forms of vascular disease?

If you have any questions regarding this information or any conclusions you draw from your assessment, please contact our office for assistance.

Please review the questions below:

  1. Do you currently have any heart issues?
  2. Do you have a family history of heart issues?
  3. Do you currently have diabetes?
  4. Do you have a family history of diabetes?
  5. Do you experience erectile dysfunction (men)?
  6. Do you smoke or have a history of smoking?
  7. Have you ever live with someone who smokes?
  8. Are you overweight?
  9. Do you eat fried or fatty foods three times a week or more?
  10. Do you have high cholesterol?
  11. Do you have a family history of high cholesterol?
  12. Do you have high blood pressure?
  13. Do you have a family history of high blood pressure?
  14. Are you over the age of 40?
  15. Do you tire or fatigue easily?
  16. Do you have swelling in your legs or feet?
  17. Do you have aching, cramping, or pain in the legs while you walk or exercise that goes away after rest?
  18. Do you have tingling, numbness, or coldness in your hands or feet?
  19. Do you have loss of hair on your feet or toes?
  20. Do you have irregular growth of fingernails or toenails?

If you answered yes to three or more of these questions, you may be at risk for peripheral vascular disease (PVD) or peripheral arterial disease (PAD). Please contact our office for more information. 

For more information on the diagnosis, treatment and procedures regarding vascular disease, visit www.vascularweb.org.

Patient Forms

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.