Venous Health Assessment

This Simple Assessment Can Help Determine Risk Factors

Vein issues like venous insufficiency is a common medical condition that affects a significant portion of the adult population, particularly those with heart and vascular issues. It is associated with many symptoms involving the legs and is often under-diagnosed.

You do not need to suffer from the effects of venous insufficiency. These types of vein conditions can be effectively treated so you can return to enjoying activities of daily living.

To help determine the health of your veins, check the box next to the list below, if you are experiencing these symptoms with your legs. * *

Aching and pain
Heaviness
Swollen ankles and legs
Red or brown discoloration
Ulcers that won't heal
Cramping
Restless legs
Throbbing
Varicose veins

If you are experiencing one or more of the above symptoms, you qualify for a vein screening. *

Yes, I would like a referral to see a specialist for a vein screening.
No, not at this time.

Name *

Phone *

Email *

Street Address *

Street Address Line 2

City *

State *

Zip Code *

Form Submissions

Please wait for the Thank You page to confirm your form has been submitted.

Featured Services

General Surgery

Robotics

The Vein Center at Midwest Surgical Specialists

Neurosciences

You will need Adobe® Acrobat® Reader to view PDF documents. Download a free copy from the Adobe Web site.