WOUND CARE QUIZ
Wound Type:
What kind of wound are you currently dealing with?
*
Diabetic foot ulcer
Surgical wound that’s not healing
Pressure sore (bed sore)
Leg ulcer or vein-related wound
I’m not sure / just a sore that won’t go away
What kind of insurance do you have?
*
Medicare
Medicaid
PPO
Hmo
Other
How long has the wound been present?
Less than 2 weeks
2–4 weeks
Over 4 weeks
Not sure
Which of these apply to your wound?
*
Pain or burning sensation
Swelling or redness
Draining or bad smell
Growing or getting worse
None of these
Do you have any of the following health conditions?
*
Diabetes
Poor circulation / vascular disease
Recent surgery
Limited mobility
None of these / Not sure
Do you prefer to receive care in our clinic or at your home?
*
In-Clinic Visit
In-Home Visit (Mobile Care)
Full Name
*
Phone
*
Email
*
What is Your Zipcode?
*
I agree to be contacted by VAC Wound Care about my wound care options.