PAD Symptom Screener

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Infusionsoft Tags

Nurture Subscriber

New Lead

New Customer

Interest - Email Series

Myself

Clean List

Duplicate Contacts

Email Typos

PAD Symptom Screener

PAD Guide

PAD Screening Scheduled

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Downloaded PAD Guide

Clicked Schedule

Completed PAD Guide Sequence

Yahoo deliverability issues 2021

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Are you 50 years old or older?* This field is required.

Yes

No

3

Do you smoke or did you smoke?* This field is required.

Yes

No

4

Have you been diagnosed with any of the following?* This field is required.

Diabetes

Chronic kidney disease

High blood pressure

High cholesterol

Coronary heart disease

Several of the above

None of the above

5

Have you been experiencing tiredness or leg pain with exertion that is relieved with rest?* This field is required.

Yes

No

6

Do you have toes or feet that become discolored when upright (with dependency)?* This field is required.

Yes

No

7

Have you experienced foot pain, numbness, or cramps that disturbs your sleep that is relieved with movement or dependency?* This field is required.

Yes

No

8

Do you have sores, wounds, or gangrene on your toes, feet, or legs that heal slowly or not at all?* This field is required.

Yes

No

9

Do you have a diabetic foot ulcer?* This field is required.

Yes

No

10

Do you have burning of feet diagnosed as neuropathy that does not respond to medication?* This field is required.

Yes

No

11

Do you have a family history of PAD, coronary disease, or stroke?* This field is required.

Yes

No

12

Please enter your name below* This field is required.We respect your privacy and your sensitive information is protected by the highest security and encryption standards in compliance with HIPAA.

13

Please enter your email below* This field is required.We respect your privacy and your sensitive information is protected by the highest security and encryption standards in compliance with HIPAA.

14

Please enter your phone number below* This field is required.We respect your privacy and your sensitive information is protected by the highest security and encryption standards in compliance with HIPAA.

Please enter a valid phone number.

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PAD Score Calculation