Vein Assessment - University Surgical Associates

Complete the assessment and a USA Vein Specialist will review your symptoms. For even better results, snap a few photos of your veins and upload them below.

Vein Symptoms

What are your symptoms? (Check all that apply)

Leg Fatigue

Leg Pain (caused by prolonged standing or sitting)

Tiredness in the Legs

Leg Heaviness

Itching of the Legs or Feet

Tingling in the Legs or Feet

Swelling of the Ankles

Skin Discoloration in the Lower Legs

Open Sores or Ulcers on Lower Legs or Ankles

Is there a history of vein problems in your blood related family?

Yes

No

I Don't Know

Is there a history of blood clots in your blood related family? *

Yes

No

I Don't Know

Do you have visible varicose veins or spider veins? *

Yes

No

I Don't Know

Have you received any prior vein treatments? *

Yes

No

I Don't Know

Please upload a picture of your area of concern. (If you do not have visible signs of vein disease, submit your information without a picture.)

Choose File

Contact Information

How would you like us to communicate your vein assessment results to you?

Email

Phone

FOR EMAIL COMMUNICATION: The use of unencrypted email is not secure. Your medical information may be viewed by an unauthorized person as it is transmitted over the internet.

Initial here if you accept this risk: