I am interested in receiving the following
information:
Optional Questionaire:
Have you previously been diagnosed with venous reflux or venous
insufficiency?
Do you have varicose veins? (Varicose veins are large, blue, bulging veins as opposed
to spider veins, which are small, thin veins that lay close to the skin
surface.)
Do you experience any of the following symptoms in your legs or
ankles?
- Leg pain, aching or cramping
- Burning or itching of the skin
- Leg or ankle swelling
- “Heavy” feeling in legs
- Skin discolorations or texture changes
- Open wounds or sores
Has anyone in your blood related family been diagnosed with
varicose veins?
Has anyone in your blood related family had vein stripping?
