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1.
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Have you previously been diagnosed with venous reflux or venous insufficiency?
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2.
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Do you have varicose veins? (Varicose veins are large, blue, bulging veins.)
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3.
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Do you have spider veins? (Spider veins are small, thin veins that lay close to the skin surface.)
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4.
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Are you concerned about varicose or spider veins detracting from your appearance?
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5.
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Do you experience any of the following symptoms?
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Leg pain, aching or cramping
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Burning or itching of the skin
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Leg or ankle swelling
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"Heavy" feeling in legs
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Skin discolorations or texture changes
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Open wounds or sores
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6.
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Has anyone in your blood related family been diagnosed with varicose veins?
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7.
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Do you have any history of deep venous thrombosis (blood clot in the leg)?
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8.
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Any other comments or concerns?
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