• Diabetic Foot Exam Checklist Form

    Complete this checklist to document a comprehensive diabetic foot examination. Select the findings that best match your clinical assessment.
  • Exam Consent & Acknowledgment: By proceeding, you confirm that the patient has been informed about the purpose of this foot examination and has provided verbal consent. Complete this checklist as part of routine clinical care.
  • Skin Condition*
  • Ulceration Present*
  • Signs of Infection*
  • Foot Deformity*
  • Pedal Pulses*
  • Monofilament Sensation (10g)*
  • Vibration Sense (Tuning Fork)*
  • Footwear Assessment*
  • Should be Empty:
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