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

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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?

May I have your zip code?

Please enter your date of birth.

mm-dd-yyyy

What is your gender?

Male Female

Do you have pain when walking or at rest, cramping, or ulcers in your leg?

Yes No

Has a doctor told you that your pain in your legs is related to arthritis or other joint disorders?

Yes No

Has a doctor told you that you may have poor blood circulation or a blockage in the large blood vessels of 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 circulation in your leg such as angioplasty, bypass graft, or placement of a stent?

Yes No Unsure

Have you had a stent or stent graft in your upper thigh, the superficial femoral artery (SFA) in the leg that has pain?

Yes No Unsure

In the past 6 months, have you had a previous blood-vessel treatment procedure, other than a stent or stent graft, in your thigh also know as the Superficial Femoral Artery (SFA) that may now need a stent procedure?

Yes No Unsure

Are you currently participating in a drug or device research study?
Yes No

Is there any medical reason you can’t take blood thinners such as Plavix, or aspirin?
Yes No Unsure
In the past 3 months, have you been hospitalized for congestive heart failure?
Yes No

In the past 30 days, have you had a stroke or heart attack?
Yes No

Do you have kidney disease requiring hemo-dialysis?
Yes No
Do you have a history of severe kidney or liver disease that was treated with a transplant?
Yes No
Do you regularly take steroid pills or injections?
Yes No