Online Questionnaire

Do you experience pain in your legs when walking? yesno

Do you have swelling in your legs? yesno

Do you have swelling in the morning? yesno

Do you have Diabetes? yesno

Have you ever had a blood clot in your legs (DVT or Deep Vein Thrombosis)? yesno

Does your job or daily activity require standing for long periods of time? yesno

Do you have any painful sores or ulcers on your legs or feet that are not healing? yesno

Do you have noticeable distended vein? yesno
Where?THIGHSCALFBEHINDKNEEANKLEFOOT

Do you have varicose veins or spider veins? yesno
Where?THIGHSCALFBEHINDKNEEANKLEFOOT

Have you ever had surgery to your veins in your legs, vein removal for open heart
surgery, vein stripping in your legs, or cosmetic vein repair? yesno

Have you ever had a test on your legs (blood pressure cuffs on your ankles),
sometimes known as PVR? yesno

Have you ever had a venous sonogram (also called venous Doppler)? yesno
If yes, when?

Do you have any of the following risk factors?High CholesterolCurrent SmokerPrevious SmokerHigh Blood PressureKidney ProblemsStrokeMini Stroke