Date of birth*

Gender*

Insurance Type*

Do you have a diagnosis or imaging studies?*

Are you currently taking blood thinners (e.g., Eliquis, Plavix, Coumadin, Effient, Aspirin) or baby aspirin?*

Are you currently taking GLP-1 agonists or SGLT-2 inhibitors (e.g., Ozempic, Mounjaro, Wegovy, Farxiga, Jardiance)?*