Please complete the following medical screening questions below to determine your eligibility. Your information will not be shared with third parties and will remain private.

Please read our privacy policy for more details.

Please Note: You do not have to answer any particular question. However, your responses will be used to determine if you are a good match for our research study.

How did you find out about this study opportunity?

What is your date of birth?

dd-mm-yyyy

What is your zip or postal code?

What is your gender?

Male Female

Do you have cramping in your leg when walking or at rest?
Yes No
Do you have ulcers on your legs, if yes please note if one or both legs.
No Yes, One Leg Yes, Both Legs
Do you have discomfort or pain in your leg that causes you to modify your activity?
Yes No
Do you have diabetes?
Yes No
Has a doctor told you that the pain in your legs is related only to arthritis or other joint disorders?
Yes No
Has a doctor told you that you may have poor blood flow or circulation or a blockage in your leg, sometimes called Peripheral Artery Disease (PAD) or Peripheral Vascular Disease (PVD)?
Yes No Unsure
Has a doctor told you that you should consider having a procedure to possibly treat the poor blood flow or circulation or blockage in your leg such as angioplasty, bypass graft, placement of a stent or atherectomy or plaque excision? [thrombectomy, brachytherapy, or use of laser devices also qualify to answer “Yes” to this Q.]
Yes No Unsure
In the past 30 days, have you had a previous blood-vessel treatment procedure in your leg?
Yes No Unsure
Are you currently participating in a drug or device research study?
Yes No