Vein Assessment Have you ever been diagnosed with varicose veins? Yes No Have you had treatment for varicose veins? Yes No Do you have a family history of varicose veins/venous reflux? Yes No During pregnancy, did you have leg swelling or bulging leg veins? Yes No Have you ever been diagnosed with varicose veins? Yes No Pains Cramping Pains Cramping Someone in our office will contact you regarding your vein assessment. Full Name Phone Number Email SUBMIT
