Vascular Health & Leg Pain Assessment Form

Vascular Health & Leg Pain Assessment: Complete Pre-Visit Screening for PAD

Early detection of peripheral arterial disease (PAD) and vascular complications can be life-changing. Our Vascular Health & Leg Pain Assessment Form provides a thorough, patient-friendly way to screen for circulation problems, claudication symptoms, wound healing issues, and amputation risk factors—all before a patient steps into your clinic.

This pre-visit symptom assessment form helps vascular surgeons, primary care providers, wound care specialists, and cardiovascular clinics identify high-risk patients, prioritize urgent cases, and prepare more targeted treatment plans. By capturing detailed claudication scales, risk factors, and symptom patterns digitally, you can streamline intake, reduce appointment time, and focus on what matters most: patient outcomes.

Why use Paperform for vascular health assessments?

Paperform is trusted by healthcare providers who need flexible, compliant, and easy-to-use forms that work for both patients and clinical teams. Unlike rigid medical form builders, Paperform's doc-style editor lets you craft assessments that feel approachable and professional—not intimidating.

With conditional logic built in, you can show follow-up questions only when relevant (like wound details if a patient reports an ulcer, or amputation history if applicable). This keeps forms shorter and more focused for each patient, improving completion rates and data quality.

What makes this template effective?

This vascular health assessment covers:

• Demographic and contact information for seamless chart integration
• Chief complaint and pain location mapping to understand symptom distribution
• Claudication severity scoring using established clinical scales
• Walking distance and functional limitation tracking
• Rest pain and nocturnal symptoms to identify critical limb ischemia
• Wound assessment including location, size, duration, and healing status
• Amputation risk factors such as diabetes, smoking, neuropathy, and prior ulcers
• Medical history relevant to vascular disease (hypertension, hyperlipidemia, renal disease)
• Medication review including anticoagulants and antiplatelet therapy
• Social and lifestyle factors that impact circulation and wound healing

By collecting this information ahead of appointments, your clinical team can:

• Triage patients effectively and identify those needing urgent vascular intervention
• Prepare diagnostic tools and imaging based on symptom severity
• Reduce in-office paperwork and maximize face-to-face consultation time
• Improve documentation quality with structured, consistent data capture
• Track outcomes over time by re-sending the form at follow-up intervals

Automate your vascular care workflows with Stepper

Once a patient submits this assessment, you can use Stepper to automatically route high-risk cases to your vascular surgery team, flag critical symptoms for immediate review, create tasks in your practice management system, or send automated pre-appointment instructions.

For example, if a patient reports rest pain, non-healing wounds, or a high claudication score, Stepper can instantly notify your care coordinator and schedule priority imaging—all without manual triage.

Secure, compliant, and ready for your practice

Paperform is SOC 2 Type II and GDPR compliant, with robust security controls that protect patient data. While not HIPAA-compliant, Paperform is trusted by thousands of healthcare teams for pre-visit screening, patient intake, and non-PHI workflows that improve care delivery.

You can embed this form on your website, send it via email before appointments, or share a direct link in appointment reminders. Responses sync to your CRM, Google Sheets, Airtable, or EMR via integrations, keeping patient information flowing smoothly into your existing systems.

Who is this template for?

This vascular health assessment is ideal for:

• Vascular surgeons evaluating peripheral arterial disease and critical limb ischemia
• Podiatrists and wound care specialists managing diabetic foot ulcers and ischemic wounds
• Primary care physicians screening at-risk patients for claudication and circulation problems
• Cardiovascular clinics offering comprehensive vascular health programs
• Hospital pre-admission teams preparing patients for vascular procedures
• Research teams studying PAD outcomes and risk stratification

Customize for your clinical protocols

Every vascular practice has unique protocols and preferred assessment scales. With Paperform, you can easily adjust claudication scoring, add institution-specific risk calculators, include consent language, or integrate your own patient education resources—all without needing a developer.

Whether you're screening for PAD in a family practice or managing complex limb salvage cases in a tertiary center, this template gives you a professional, patient-centered starting point that you can make your own.

Start improving your vascular care intake today with Paperform's Vascular Health & Leg Pain Assessment—because better information before the visit means better outcomes after.