Peripheral artery disease (PAD) is a common circulatory problem in which arteries carrying blood to the legs are not functioning well and become narrowed or clogged due to a build-up of plaque.

P.A.D. Self Assessment Tool

If you can answer yes to any of the questions below, talk to your primary care physician or contact our office to schedule an evaluation and screening for P.A.D.

Click here to download and print the questionnaire

1. (Yes or No) Have you ever been diagnosed as having poor circulation?

2. (Yes or No) Have you ever had surgery, balloon procedures or stents in your heart, kidneys, abdomen, legs or arms?
*If you answered “YES”, please have a list of the approximate dates of these procedures at the time of your appointment.

3. (Yes or No) When walking, do you experience aching, cramping or pain in your legs, thighs or buttocks?

4. If “YES” to question 3, when do you feel the pain?

  • After walking 1 block
  • Climbing a flight of stairs
  • After walking 100 yards (length of a football field)
  • Walking at increased speed

5. If “YES” to question 3, in what areas of the body do you experience pain?

  • Head or neck
  • Arms
  • Upper body
  • Abdomen
  • Pelvic region
  • Thighs
  • Calves
  • Feet

6. (Yes or No) If you do have pain, does it get better after you’ve rested?

7. (Yes or No) Do your feet or toes bother you most nights while lying in bed, with relief when they are dangled at the edge of the bed?

8. (Yes or No) Do you have painful sores or ulcers on your legs or feet that do not heal?

9. (Yes or No) Are your legs discolored or bluish?

10. (Yes or No) Do you smoke currently? Do you have a history of smoking?

11. (Yes or No) Do you or a family member have diabetes?

12. (Yes or No) Do you or a family member have high cholesterol?

13. (Yes or No) Do you or a family member have high blood pressure or hypertension?

14. (Yes or No) Do you or a family member have/had coronary artery disease (CAD) or heart attack?

15. (Yes or No) Have you or a family member had a stroke, mini-stroke or TIA?

Learn More About P.A.D.

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