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               Are you a Male over the age of 50  
  
  
  
  
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               Are you a Female over the age of 65 
  
  
  
  
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               Do you currently smoke 
  
  
  
  
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               Are you a former smoker  
  
  
  
  
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               Do you have high blood pressure or take HBP medication  
  
  
  
  
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               Do you have Diabetes  
  
  
  
  
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               | 
          
          
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               Do you have a history of Heart Disease (heart attack, MI)?  
  
  
  
  
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               | 
          
          
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               Do you have a history of stroke or mini-stroke (TIA)  
  
  
  
  
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               Do you have high Cholesterol or other blood lipid (fat) problems or require cholesterol medication?  
  
  
  
  
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               Do you have a history of chronic kidney disease or on dialysis  
  
  
  
  
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               Do you have a history of carotid stenosis, AAA or stet placement?  
  
  
  
  
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               Unlikely problems with Peripheral Arterial Disease (PAD) 
  
  
  
  
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               Questionable, Your physician can help determine if this may be a concern. 
  
  
  
  
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                Likely benefit from a painless, non-invasive test for peripheral arterial disease 
  
  
  
  
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               | 
          
          
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               Total 
  
  
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               Vascular Centers of America 
  
  
  
  
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               248-234-6799 
  
  
  
  
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