Peripheral artery disease (PAD) affects millions of people worldwide, yet early detection and intervention can significantly improve outcomes and quality of life. This Peripheral Artery Disease Screening Form provides healthcare providers with a structured, comprehensive tool to evaluate patients for PAD risk, document ankle-brachial index (ABI) results, assess claudication symptoms, and develop evidence-based intervention plans.

Designed specifically for vascular specialists, primary care physicians, cardiovascular clinics, and preventive health programs, this form streamlines the PAD assessment process from initial symptom evaluation through to treatment planning. The structured format ensures consistent data collection across your practice while making it easy to identify high-risk patients who need immediate intervention.

The form captures essential vascular risk factors including smoking history, diabetes, hypertension, and hyperlipidemia—all critical components of PAD risk stratification. It includes detailed claudication symptom assessment using standardized questions about leg pain, walking distance limitations, and symptom patterns that help differentiate PAD from other conditions.

Healthcare teams can document ankle-brachial index measurements with precision, record ABI values for both legs, and categorize results according to established clinical guidelines. The form's conditional logic adapts based on severity, ensuring appropriate follow-up recommendations are captured for each patient's unique situation.

Paperform makes this PAD screening process seamless and professional. With HIPAA-compliant submission handling, you can securely collect sensitive patient data while maintaining full compliance. The form's conditional logic automatically reveals relevant follow-up questions based on risk factors and ABI results, creating a personalized assessment experience that saves clinical time.

For practices looking to integrate this screening data into existing workflows, Stepper (stepper.io) can automate what happens next. Connect your PAD screening results to your EHR system, trigger appointment scheduling for high-risk patients, send educational materials based on specific risk factors, or create task lists for care coordinators—all without manual data entry.

Whether you're conducting community health screenings, managing a vascular clinic, or implementing preventive cardiovascular programs, this template provides the clinical structure and workflow efficiency needed to deliver exceptional patient care while identifying PAD early when interventions are most effective.