Online Vein Screening Survey

Do you have any of the following signs, symptoms or history? (Check all that apply)
Varicose veinsSpider veinsLeg painLeg swellingSwelling of the feetVenous ulcerPelvic varicose veinsLymphedemaHistory of Deep Vein Thrombosis (DVT)

Do you have pain when sitting, standing or both?
Pain while sittingPain while standingPain while sitting & standing

Do you have a family history of vein disease?
YesNo

Would you like more information on Vein disease?
YesNo

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