Please take this self-assessment to see if you might be a candidate for additional screening for potential varicose veins and / or chronic venous insufficiency.
History
| Have you ever had varicose veins? | O Yes | O No |
Signs and Symptoms
Do you experience any of the following signs and symptoms in your legs or ankles?
| Do you experience leg pain, aching or cramping? | O Yes | O No |
| Do you experience leg or ankle swelling, especially at the end of the day? | O Yes | vO No |
| Do you feel “heaviness” in your legs? | O Yes | O No |
| Do you experience restless legs? | O Yes | O No |
| Do you have skin discoloration or texture changes? | O Yes | O No |
| Do you have open wounds or sores? | O Yes | O No |
Risk Factors
| Has anyone in your blood-related family ever had varicose veins or been diagnosed with venous reflux disease or chronic venous insufficiency? | O Yes | O No |
| Have you had any treatments or procedures for vein problems? | O Yes | O No |
| Do you stand for long periods of time, such as at work? | O Yes | O No |
Self-Assessment Results
If you answered yes to one or more of the above questions, please contact us for a consultation to see if you may be developing venous reflux disease.