Patient Risk Assessment

12 questions. 2 minutes. Could save your life.

A simple yes/no questionnaire that identifies who in your patient base is most at risk for PAD and most likely to benefit from screening — based on documented Medicare-recognized risk indications.

Why It Matters

12Yes/no questions — takes 2 minutes

2+Yes answers means a patient qualifies

3 of 4Adults with PAD don't know they have it

10 yrsEarlier detection vs. traditional methods

Risk Questionnaire

Your PAD Risk Snapshot

This is an awareness tool — not a diagnosis. Bring your answers to your physician for a clinical conversation.

Are you age 50 or older?
Do you have diabetes (type 1 or type 2)?
Do you currently smoke or have you smoked within the last 10 years?
Do you have high blood pressure?
Do you have high cholesterol?
Do you have a family history of heart attack, stroke, or PAD?
Do you experience leg pain, cramping, or fatigue when walking that improves with rest?
Have you noticed cold feet, numbness, or skin color changes in your legs?
Do you have a slow-healing wound or sore on your feet or legs?
Have you been diagnosed with kidney disease or heart disease?
Are you of African American, Hispanic, or Indigenous heritage (higher PAD prevalence)?
Do you live a primarily sedentary lifestyle?

Connect Me With a Screening Site

For Providers

Use this in your waiting room.

Practices using Pulse4Physicians can deploy this questionnaire as a paper or tablet intake. Patients answering "yes" to two or more items become candidates for the 3-test screening protocol — captured under standard Medicare-recognized risk indications.

Request the Provider Information Kit

The Next Step

Ready to bring Pulse4Physicians to your organization?

15 minutes. No commitment. We'll walk you through the program, the billing, and how Pulse4Pulse delivers PAD screening at your practice.

Schedule a 15-Min Call Open Calendly