Step 2: Free PAD Online Assessment

Finish this quick ONE MINUTE assessment. This can help you identify potential

Vascular Disease Symptoms

Determine if you may be at RISK for developing Peripheral Artery Disease (PAD) then schedule a

Free PAD Consultation at our nearest clinic in your area

Gender *

Gender

Male
Female
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Do you Have Diabetes?

Yes

Do you have High Cholesterol?

Yes

Are you Over 50 years Old? *

Yes

Does Your Family Have a History of Diabetes? *

Yes

Do you Currently Smoke? Have you ever smoked?

Yes

Occasionally

Never

Do you have aching, cramping, tingling, or pain in your legs when you walk or exercise that is relieved by rest?

Yes

Do you have pain in your toes or feet at night?

Yes

Do you experience leg numbness, weakness or a difference in temperature in your lower leg or foot?

Yes

Have you noticed a change in the color of your legs?

Yes

Do you have ulcers or sores on your feet or legs that are slow in healing?

Yes

Ready to get your PAD treatment?

Yes, I am ready to schedule my free PAD consultation

Not sure - I have some questions.

I do not want fix my Arterial Problem

Not sure- I have some questions

Payment for treatment

I have insurance

I have no insurance

Cherry Financing

I'll Pay Cash

CareCredit

If you don't have or your insurance is not in our list. You could choose with our other payment options for your treatment.

Cash / Out of Pocket

Cherry Financing

CareCredit

Please write your insurance from the list below. if you cannot find your insurance in the list, please write it above (then click next)

Please choose your preferred day for your consultation (select all that apply)

Monday

Tuesday

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Friday

Please choose your preferred time (select all that apply)

8:00 AM

9:00 AM

10:00 AM

11:00 AM

1:00 PM

2:00 PM

3:00 PM

3:45 PM

Please provide the following we'll use this to schedule your Free appointment

13. First Name *

14. Last Name *

15. Confirm your best email address: (Then press enter/Next) *

16. Verify Your Current Mobile Phone Number: (Then press Enter/Next) *

Zip Code

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