Vein & Vascular Questionnaire

Am I a candidate?

Fields marked with an * are required

Do you experience any pain at rest in your lower leg(s) or feet?
Do you have foot, calf, buttock, hip, or thigh discomfort (aching, fatigue, tingling, cramping, or pain) when you walk, which is relieved by rest?
Are your toes or feet pale, discolored, or bluish?
Do you have an infection, skin wound, or ulcer on your feet or toes that are slow to heal (8-12 weeks)?
Do you have high cholesterol levels, or other blood lipid problems, or do you take medication to lower cholesterol?
Do you have high blood pressure or take medication for high blood pressure?
Do you have diabetes?
Have you ever smoked?
Have you previously had a stroke?
Do you have heart disease?
First & Last