Think You Might Have a Vein Problem? Take our Self-Assessment! Step 1 of 5 20% What is your gender?(Required) Male Female Prefer Not to Say Have you ever experienced any of the following symptoms?(Required) Ankle and/or leg swelling Heavy or Fatigued Legs Skin Discoloration or Texture Change Burning or Itchy Legs Leg Cramping Restless Legs Sores or Open Wounds Difficulty Moving None of the Above How long have you had these unwanted symptoms?(Required) 0-3 months 3-6 months 6-12 months 1-2 Years 2-5 Years 5+ Years Did the symptoms start occurring after a pregnancy?(Required) Yes No I’m Not Sure What action have you taken to try and eliminate this problem?(Required) Went to a Vein Care Specialist Wore Compression Socks Tried Vein Cream Exercise New Diet Discussed Problem with my PCP Other Have the actions you have taken made a difference in your unwanted symptoms?(Required) Yes Somewhat No Are you looking to solve this problem permanently?(Required) Yes No What type of insurance do you carry?(Required)Select an optionPPO (Preferred Provider)HMO (Health Maintenance)MedicareMedicaidSelf-PayOtherBased on your response we can better respond to your needsThis field is hidden when viewing the formTotal Score Based on your results, you may be showing signs of vein disease. Please fill out the form below to have one of our staff members reach out to you. Medical Disclaimer: This quiz is a general screening tool and does not constitute medical or professional advice. If you’re in crisis or feel unsafe, seek immediate help from local emergency services.Your responses indicate low concern at this time. However, if you would like to speak with one of our primary care specialists, please complete the Contact Us form below, and a member of our team will reach out to you. Thank you! Medical Disclaimer: This quiz is a general screening tool and does not constitute medical or professional advice. If you’re in crisis or feel unsafe, seek immediate help from local emergency services.Name(Required) First Last Phone(Required)Email(Required) Δ
