TRUST YOUR LEGS TO A VASCULAR SURGEON
Forms & Insurance
The following self assessment will help determine if you may benefit from a vein or vascular treatment from Stevens Vein & Vascular.
Step 1 of 3 - Basic Information and Medical History
Date of Birth
Local Zip Code
Do you have leg pain?
Do you have swelling of the ankle or leg?
Do you have visible varicose veins?
Have you had major surgery lasting over an hour in the last month?
Are you pregnant or had a baby within the last month?
In the past month, if you have felt pain in the legs, what was the intensity of this pain?
Using the images below as a reference, please check the condition below that correspond to the condition of your legs.
No visible signs of venous disease
Spider veins, reticular veins, malleolar flare
Swelling without skin changes
Chronic skin changes (pigmentation, eczema, thickened skin)
Chronic skin changes with healed ulceration
Chronic skin changes with active ulceration
Stevens Vein & Vascular respects the privacy of its patients and website visitors. Our website collects names, email addresses, and other personal information when submitted via one of our online forms. However, this data is used solely by Stevens Vein & Vascular and is not shared, traded, or sold to third parties.
This field is for validation purposes and should be left unchanged.