WELCOME TO THE SELF ASSESSMENT QUIZ Have you ever suffered from spider or varicose veins? Yes, Spider Veins Yes, Varicose Veins Other Vein Issues No 1 out of 5 If you have been diagnosed, did you undergo any treatments? Yes No 2 out of 5 Has anyone in your family suffered from vein disease, varicose veins, or spider veins? Yes No 3 out of 5 Have you ever experienced any of the following symptoms? Swelling in the Legs or Ankles Heavy or Fatigued Legs Skin Discoloration or Texture Change Burning or Itchy Legs Leg Cramping or Aching Restless Legs Sores or Open Wounds Difficulty Moving None of the Above 4 out of 5 Do you stand or sit for long periods of time? Yes No 5 out of 5 First Name Last Name Phone Number Email