Baptist Health Care

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Peripheral Vascular Disease Screening 

The purpose of this inventory is to establish whether you are at risk for Peripheral Vascular Disease (PVD).  Please complete all questions. 

Yes No
1. Do you have cardiovascular (heart) problems such as high blood pressure, heart attack, or stroke?
2. Do you have diabetes?
3. Do you have a family history of diabetes or cardiovascular problems (immediate family such as parent, sisiter, brother)?
4. Do you have aching, cramping or pain in your legs when you walk or exercise, but then the pain goes away after you rest?
5. Do you have pain in your toes or feet at night?
6. Do you have any ulcers or sores on your feet or legs that are slow in healing?
7. Do you smoke?
8. Have you ever smoked?
9. Are you more than 25 pounds overweight?
10. Do you eat fried or fatty foods three times a week or more?
11. Do you have an inactive lifestyle?
Pensacola FL Florida