1. Have you or anyone in your family previously been diagnosed with varicose veins or venous reflux?

2. Do you have varicose veins which exhibit any of the following characteristics:

• Large, bulging veins on your legs
• Swollen, red, or warm to the touch
• Skin discoloration or texture changes

3. Are you experiencing any of the following symptoms in your legs, ankles, or feet:

• Pain (an aching or cramping feeling)
• Heaviness / Tiredness
• Burning or tingling sensations
• Tender areas around the veins
• Sores or skin ulcers near the ankle
• Swelling

4. Have you previously had skin ulcers on the leg (or areas that were slow to heal)?

5. Have you previously attempted conservative treatments without success (e.g. exercise, weight loss, elevating legs, avoiding long periods of standing/sitting, compression stockings)?