Cuestionario de Tamizaje para Insuficiencia Venosa Superficial

Full Name*

First NameLast Name

Email

example@example.com

Do you have a heavy feeling in your legs at the end of the day?

YesNo

Do you notice swelling in your ankles or legs, especially in the afternoon or after standing for long periods?

YesNo

Do you have visible varicose veins (swollen, twisted veins) in your legs?

YesNo

Choose the photo that most closely resembles the visible veins you have*

Spider VeinsReticular VeinsVaricose Veins

Do you suffer from night leg cramps?

YesNo

Do you have areas of hardened skin or color changes on your lower legs?

YesNo

Do you experience itchy legs, especially around swollen veins?

YesNo

Do you notice relief in your leg symptoms when you elevate your legs or wear compression stockings?

YesNo

Have you had episodes of venous eczema or venous leg ulcers that heal slowly?

YesNo

If you score 5 points or more, it is important to schedule an appointment to obtain the appropriate diagnosis and treatment for your health.

This questionnaire is a screening tool and does not replace professional medical diagnosis. If you experience any of these symptoms, seeing a doctor for a complete evaluation is important.

By responding to this survey, I acknowledge and agree that my data may be used for the study and that my responses may be used anonymously for analysis. My data will not be shared without my explicit consent, except as required by law. I agree that North Toronto Surgical / Ontario Vascular may use, process and store my data by their privacy policy. I declare that I provide this information voluntarily and may withdraw my consent at any time without affecting the lawfulness of prior processing.

Quiz for Superficial Venous Insufficiency