Peripheral Artery Disease Support Survey
Help us better understand your experience with PAD and how we can support you.
Full Name
First Name
Last Name
Age
*
Gender
Male
Female
Non-binary
Prefer not to say
Have you been diagnosed with Peripheral Artery Disease (PAD)?
*
Yes
No
Not sure
How often do you experience the following symptoms?
*
Rows
Never
Rarely
Sometimes
Often
Always
Leg pain when walking
1
2
3
4
5
Numbness or weakness in legs
6
7
8
9
10
Sores on legs or feet
11
12
13
14
15
Coldness in lower leg or foot
16
17
18
19
20
How much does PAD impact your daily life?
*
No impact
1
2
3
4
5
6
7
8
9
Severe impact
10
1 is No impact, 10 is Severe impact
Which treatments or interventions are you currently using? (Select all that apply)
Medications
Lifestyle changes (e.g., exercise, diet)
Surgical procedures
Physical therapy
No current treatment
Other
What barriers, if any, do you face in managing your PAD?
Cost of treatment
Access to healthcare providers
Lack of information
Side effects of treatment
Transportation issues
Other
How interested are you in the following support resources?
Rows
Not interested
Somewhat interested
Very interested
Educational materials about PAD
21
22
23
Support groups (in-person or online)
24
25
26
One-on-one counseling
27
28
29
Exercise programs
30
31
32
Diet and nutrition guidance
33
34
35
How would you rate your overall satisfaction with your current PAD support?
*
1
2
3
4
5
Please share any additional comments or suggestions to help us improve support for PAD.
Submit Survey
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