Quiz for Superficial Venous Insufficiency
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
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Do you have a heavy feeling in your legs at the end of the day?
*
Yes
No
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Do you notice swelling in your ankles or legs, especially in the afternoon or after standing for long periods?
*
Yes
No
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Do you have visible varicose veins (swollen, twisted veins) in your legs?
*
Yes
No
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Choose the photo that most closely resembles the visible veins you have
*
Spider Veins
Reticular Veins
Varicose Veins
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Do you suffer from night leg cramps?
*
Yes
No
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Do you have areas of hardened skin or color changes on your lower legs?
*
Yes
No
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Do you experience itchy legs, especially around swollen veins?
*
Yes
No
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Do you notice relief in your leg symptoms when you elevate your legs or wear compression stockings?
*
Yes
No
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Have you had episodes of venous eczema or venous leg ulcers that heal slowly?
*
Yes
No
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