This is a Web-based version of the Caprini DVT Risk Assessment.

Only your doctor can determine if you are at risk for Deep Vein Thrombosis (DVT), a blood clot that forms in one of the deep veins of your legs. A review of your personal history and current health may determine if you are at risk for developing this condition.

Take a moment to complete this form for yourself (or complete it for a loved one). Then be sure to talk with your doctor about your risk for DVT and what you can do to help protect against it. Your doctor may want to keep a copy in your file for future reference.

Beginning on the next page, you will be asked a series of questions. At the end, you will learn your Caprini DVT Risk Assessment score and what it means. You also will be able to view or print your responses.

Proceed to the Assessment Questionnaire