Questionnaire about Veins

1. Have you previously been diagnosed with venous reflux or venous insufficiency?

2. 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.)

3. Do you experience any of the following symptoms?

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

4. Has anyone in your blood related family been diagnosed with varicose veins?

5. Has anyone in your blood related family had vein surgery?