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Vein Quiz

Vein Quizallison2020-02-22T02:57:06+00:00

Are you concerned about the appearance of your legs?*
- Yes
- No
Do you have enlarged veins on your legs?*
- Yes
- No
Do the veins cause bumps that can be felt under the skin?*
- Yes
- No
Do you experience aching of the legs after standing or walking for a long time that interferes with your daily life?*
- Yes
- No
Do you experience swelling of the lower legs?*
- Yes
- No
Please check all boxes that apply
- Is there a history of vein problems in your bloodrelated family?
- Are you fatigued, tired, or have heavy-feeling legs?
- Do you have visible varicose and/or spider veins?
- Do you have leg pain caused by prolonged standing or sitting?
- Is there itching, tingling, numbness, cramping or burning in your legs or feet?
- Do you have swollen ankles at the end of the day?
- Do you have discoloration of the skin in your lower legs?
- Do you have open sores or ulcers of the lower legs and ankles
Name*
Email*
Phone*
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