Patient Self-Assessment
Patient Self-Assessment
Please take this self-assessment to see if you might be a candidate for additional screening for potential varicose veins and / or chronic venous insufficiency.
History
|
Have you ever had varicose veins? |
Yes |
No |
Signs and Symptoms
Do you experience any of the following signs and symptoms in your legs or ankles?
|
Do you experience leg pain, aching or cramping? |
Yes |
No |
|
Do you experience leg or ankle swelling, especially at the end of the day? |
Yes |
No |
|
Do you feel “heaviness” in your legs? |
Yes |
No |
|
Do you experience restless legs? |
Yes |
No |
|
Do you have skin discoloration or texture changes? |
Yes |
No |
|
Do you have open wounds or sores? |
Yes |
No |
Risk Factors
|
Has anyone in your blood-related family ever had varicose veins or been diagnosed with venous reflux disease or chronic venous insufficiency? |
Yes |
No |
|
Have you had any treatments of procedures for vein problems? |
Yes |
No |
|
Do you stand for long periods of time, such as at work? |
Yes |
No |
Dr.
V.Balaji
M.S(Gen),FRCS(Eng),
FRCS(Edin),FRCS(Gen),FICS.
Senior Consultants-Vascular
Surgeon,
Apollo Hospital Chennai.
Tagline
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