Vein Self Evaluation

We invite you to take this quick, free online self evaluation to see if vein treatment is right for you.

Personal Information:

Symptoms and Past Treatments:


Do you experience any of the following symptoms? (check all that apply)


Varicose Veins
Spider or Blue Veins
Leg Swelling
Aching Legs
Leg Pain





Does any of the following improve your condition temporarily? (check all that apply)


Elevation
Compression
Anti-inflammatories
Rest
Compression
Diuretics

Which statement below best describes how your legs feel? (check all that apply)


No previous treatments
Elevation
Compression
Anti-inflammatories
Pain medications
Endovenous ablation (laser, EVLT or radio-frequency)
Sclerotherapy
Vein stripping
Cauterization or suturing of a bleeding vein
Wound care, skin graft or unna boot

Which statement below best describes how your legs feel? (check all that apply)



Additional Information:


Does anyone in your family have a history of venous disease (varicose veins, spider veins or swollen legs)?






Upload Photos of Your Varicose Veins (optional):


Drop files here




How did your hear about us?