Vein Health Clinics Winter Haven

1121 1st Street South, Winter Haven FL 33880

Vein Health Clinics Winter Haven

1121 1st Street South, Winter Haven FL 33880

FREE Online PAD (Peripheral Artery Disease) Health Assessment by Vein Health Clinics Winter Haven

This online assessment can help identify if you have vascular disease symptoms you may be experiencing and whether you may be at risk of developing peripheral artery disease. Please complete the short assessment and schedule your free appointment after.

This pre-assessment takes 45 seconds to complete

Please confirm your contact details are correct. We will send you your results to the e-mail below:

First Name *

Last Name *

Email *

Phone *

I agree to receive marketing messaging from Vein Health Clinics Winter Haven at the phone number provided above. I understand I could frequently receive messages, data rates may apply, and reply STOP to opt-out.

Date of Birth *

Zipl code *

Gender *

Female

Male

Do you Have Diabetes?

Yes

Do you have High Cholesterol?

Yes

Are you Over 50 years Old?

Yes

Does Your Family Have a History of Diabetes?

Yes

Do you Currently Smoke? Have you ever smoked?

Yes

Occasionally

Never

Do you have aching, cramping, tingling, or pain in your legs when you walk or exercise that is relieved by rest?

Yes

Do you have pain in your toes or feet at night?

Yes

Do you experience leg numbness, weakness or a difference in temperature in your lower leg or foot?

Yes

Have you noticed a change in the color of your legs?

Yes

Do you have ulcers or sores on your feet or legs that are slow in healing?

Yes

Please provide your Insurance

Blue Cross Blue Shield

Florida Blue

United Health Care

Cigna

Aetna

Humana

Medicaid

Medicare

Oscar Health

Cash/Out of Pocket

No Insurance

Other Insurance

If you're a candidate for PAD TREATMENT how ready are you to get rid of those artery issues?

Yes I am Ready to Schedule a PAD Consultation

I do not want to fix my artery problem