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* 1. Name

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* 2. Email

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* 3. Do you evaluate cardiovascular risk factors for suspected CLTI patients (check all that apply)

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* 4. Do you counsel your patients on any of the following: (check all that apply)

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* 5. Do you routinely evaluate your CLTI patients using classification system?

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* 6. Which of the following classification system do you use currently for staging your patients? (check all that apply)

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* 7. How confident are you using the staging systems?

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* 8. How helpful do you find the staging system in your clinical practice?

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* 9. Which of the following do you currently use to assess the severity of CLTI in your patients? (check all that apply)

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* 10. How confident are you in assessing the severity of  your CLTI patients?

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* 11. Do you prescribe your CLTI patients any of the following?

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* 12. How confident are you in prescribing your CLTI patients statins?

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* 13. Which of the following do you currently use to assess the quality of life in your CLTI patients  ? (check all that apply)

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* 14. How confident are you in assessing the quality of life in your patients with CLTI?

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* 15. Do you currently include patients in the development of their treatment plan?

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* 16. A 74 year-old woman weighing 55 kg presents to your office with hypertension, hyperlipidemia and intermittent, nocturnal rest pain. She does not have an ulcer, gangrene or any signs of foot infection She is on antihypertensive therapy, high dose statin, and antiplatelet therapy. Her BP is 118/68 and her most recent LDL is 65. You consider this patient’s medical management to be:

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* 17. A 74 year-old woman recently developed a shallow distal toe ulcer with a small rim of cellulitis and no exposed bone. Her ABI is 0.79; toe pressure is 52 mm Hg. The correct WIfI classification, stage and amputation risk are: 

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* 18. The GLASS system relies on the concept of a target artery path (TAP) selected by the treating physician after a diagnostic angiogram study has been obtained. Which of the following statements regarding the TAP are correct?

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* 19. How frequently have you utilized the SVS global guideline. 

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* 20. How frequently have you utilized the SVS global guideline based for pocket guides.

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* 21. How frequently have you utilized the SVS global guideline calculators

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