1121 1st Street S, Winter Haven, FL 33880

1000 Executive Dr Ste 8,

Oviedo, Florida

Complete this assessment and claim your complimentary consultation today with one of our highly skilled vascular health professionals at a conveniently located Central Florida Vascular Health Center near you.

This quick ONE MINUTE assessment can help you identify potential

Vascular Disease Symptoms

Determine if you may be at RISK for developing Peripheral Artery Disease (PAD).

To get started, please verify your 5-digit zip code: (Then Press Enter Next) *

Gender

Male
Female
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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

Payment for treatment

I have insurance

I have no insurance

Cherry financing

I'll pay cash

CareCredit

Please choose in our insurance list below (Then click Next)

If you don't have or your insurance is not in our list. You could choose with our other payment options for your treatment.

Cash / Out of Pocket

Cherry Financing

CareCredit

11. Choose your preferred day to have your appointment (select all that apply)

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Friday

Saturday (only once a month)

12. Choose your preferred time (select all that apply)

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11:00 AM

12:00 PM

1:00 PM

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3:00 PM

12. Choose your preferred time (select all that apply)

8:00 AM

9:00 AM

10:00 AM

11:00 AM

12:00 PM

1:00 PM

2:00 PM

3:00 PM

4:00 PM

5:00 PM

Please provide the following we'll use this to schedule your Free appointment

13. First Name *

14. Last Name *

15. Confirm your best email address: (Then press enter/Next) *

16. Verify Your Current Mobile Phone Number: (Then press Enter/Next) *

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