Varicose Veins Self-Assessment

Self Assessment

  • History

  • Signs And Symptoms

  • Risk Factor

  • Optional Patient Photo Upload Instructions: We are recommending that you submit a photo of your legs with your self-assessment. Please provide a full front and a back photo (1 each) in natural light with your smart phone, tablet, or quality digital camera, of your entire legs, and then upload the files to the form.
  • Max. file size: 10 MB.
  • Max. file size: 10 MB.
  • Please share your contact information

  • If you come in for a visit, how would you pay?
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