I hereby give my consent to participate in a healthcare questionnaire for the purpose of screening for Peripheral Vascular Disease (PVD) and to receive recommendations for further tests as deemed necessary by the AI-generated algorithm.

Purpose: The purpose of this questionnaire is to gather relevant medical information to assess the risk factors and symptoms associated with Peripheral Vascular Disease (PVD) and to provide recommendations for further diagnostic testing.

Confidentiality: I understand that the information collected through this questionnaire will be kept confidential and will only be shared with my primary care physician. I authorize the sharing of this information for the sole purpose of facilitating my healthcare management and ensuring continuity of care.

Data Usage: I understand that the data collected from the questionnaire will be used solely for the purpose of generating recommendations for further diagnostic tests or screenings. I consent to the use of this data by the AI-generated algorithm to provide personalized recommendations based on my medical history and current health status.

Recommendations: I acknowledge that based on the information provided in the questionnaire, the AI-generated algorithm may recommend further tests such as ultrasound and/or Ankle-Brachial Index (ABI) testing. I understand that these recommendations are made in the interest of my health and well-being and may assist my primary care physician in making informed decisions regarding my healthcare.

Voluntary Participation: I understand that participation in this questionnaire is voluntary, and I have the right to refuse to answer any questions or withdraw from the questionnaire at any time without penalty.

Risks and Benefits: I understand that while participating in this questionnaire and following the recommendations for further diagnostic testing may provide potential benefits to my health by identifying and diagnosing Peripheral Vascular Disease (PVD) early, there may also be risks associated with undergoing additional testing, including but not limited to discomfort, inconvenience, and potential financial costs.

Informed Consent: I have read and understand the information provided in this consent form. I have had the opportunity to ask questions and have received satisfactory answers to my inquiries. By clicking ‘I Agree’ on the screen, I hereby give my informed consent to proceed with the collection of data and receive recommendations for further diagnostic testing.

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