When looking at your legs, how visible are your veins? *

They’re there but not too obvious

They’re visible, and I’m a bit self-conscious

Very prominent and hard to ignore

How would you describe any pain or discomfort from your veins? *

Occasionally, I feel some mild discomfort

I often feel a heavy sensation or throbbing

It’s painful and affects my daily activities

Have you noticed any skin changes, like dryness or discoloration, near the affected veins? *

Maybe a slight change, but nothing bothersome

Yes, I see noticeable color or texture changes

Significant changes; it’s affecting my skin health

Do you feel numbness, tingling, or a “heavy” sensation in your legs? *

Rarely, if I’ve been sitting or standing too long

Yes, often after a full day on my feet

Daily, it’s uncomfortable and distracting

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First Name *

Last Name *

Phone *

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New Patient ( Yes or No?) *