Do You Experience or Suffer From Any of the Following Signs or Symptoms in Your Legs?

Select All That Apply

Do You Experience or Suffer From Any of the Following Signs or Symptoms in Your Legs?

Leg heaviness or fatigue

Restless legs

Itching or burning of the skin

Leg or ankle swelling

Numbness or tingling of the feet

Leg pain, aching, cramping, or throbbing

Skin discoloration or texture change

Open wounds, sores, or venous ulcers

Have You Ever Been Diagnosed With Spider Veins?

Yes

No

Have You Ever Been Diagnosed With Varicose Veins?

Yes

No

Have You Ever Been Diagnosed With Blood Clots?

Yes

No

Have You Had Any Previous Vein Treatments?

Yes

No

What Vein Treatments Have You Had?

Laser therapy

Phlebotomy

Radiofrequency Ablation

Sclerotherapy

Vein stripping surgery

VenaSeal

Varithena

Other

Has Anyone In Your Blood-Related Family Ever Had Varicose Veins or Been Diagnosed With Venous Disease?

Yes

No

What Types of Vein Diagnoses Have Your Blood Relatives Been Given?

Select All That Apply

What Types of Vein Diagnoses Have Your Blood Relatives Been Given?

Varicose veins

Venous insufficiency

Deep vein thrombosis

Vein stripping

Blood clots

Has anyone in your blood-related family had any of the following?

Blood coagulation disorder

Stroke

Heart attack

Pulmonary embolism

Do You Stand Or Sit For Long Periods Of Time?

Yes

No

Do You Exercise Regularly?

Yes

No

Do You Currently Smoke?

Yes

No

Approximately How Long Have You Been Smoking?

Are You Currently Pregnant?

Yes

No

Have You Ever Been Pregnant?

Yes

No

How ManyPregnancies Have You Had?

Have You Been Diagnosed With Any of the Following?

Select All That Apply

Have You Been Diagnosed With Any of the Following?

Diabetes

Heart disease

High blood pressure

High cholesterol

Let Us Know Where to Send Your Results.

Name*

Phone*

Email*

Which location would you like to visit?*

Venice

Wellen Park

Lakewood Ranch

Sebring

Phone

This field is for validation purposes and should be left unchanged.

Vein Screening Tool

Discover How Florida Lakes Can Help You Reclaim Your Health and Comfort!

Do You Experience or Suffer From Any of the Following Signs or Symptoms in Your Legs?

Have You Ever Been Diagnosed With Spider Veins?

Have You Ever Been Diagnosed With Varicose Veins?

Have You Ever Been Diagnosed With Blood Clots?

Have You Had Any Previous Vein Treatments?

What Vein Treatments Have You Had?

Has Anyone In Your Blood-Related Family Ever Had Varicose Veins or Been Diagnosed With Venous Disease?

What Types of Vein Diagnoses Have Your Blood Relatives Been Given?

Has anyone in your blood-related family had any of the following?

Do You Stand Or Sit For Long Periods Of Time?

Do You Exercise Regularly?

Do You Currently Smoke?

Approximately How Long Have You Been Smoking?

Are You Currently Pregnant?

Have You Ever Been Pregnant?

How ManyPregnancies Have You Had?

Have You Been Diagnosed With Any of the Following?

Let Us Know Where to Send Your Results.

Thank you for using the Florida Lakes Vein Center screening tool!

Vein Screening Tool