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Vein Assessment
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1
What is your gender?
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Male
Female
Prefer Not to Say
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2
Have you ever experienced any of the following symptoms?
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Choose as many as you like
Leg Cramping or Aching
Itching or Burning Legs
Restless Legs
Skin and Texture Change
Leg Heaviness and Trouble Moving
Open Wounds and Sores
None of the Above
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3
How long have you been experiencing these symptoms?
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1 month or less
1 - 3 months
3 - 6 months
6 - 12 months
1 -2 years
2 years +
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4
What have you tried in the past to help solve these symptoms?
*
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Compression socks
Went to vein specialist
Diet & Excercise
Topical Vein Creams
Had a previous vein procedure
None of the Above
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5
Has what you done made you seen a difference from these symptoms?
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Yes
Somewhat
No
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6
Enter your insurance
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7
Based on your results, you may be showing signs of vein disease. Please enter your email below to get your video.
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Based on your results, you may be showing signs of vein disease. Please enter your email below to get your free guide.
Please enter your phone
Please enter your email
Please enter your name
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