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Online Vein Screening
Welcome to MyVeinScreening.com. You are taking the first step to healthier feeling and looking legs through a confidential online screening - all in the convenience and privacy of your home. By answering a few simple questions and uploading your photo(s), a board certified vascular specialist will review and make an evaluation of your venous concerns. If a formal vein consultation is recommended, you will be notified and given the information necessary to make an informed decision about which treatment option, if any, is right for you. Let’s get started!
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What is your main concern?
Do you experience?
varicose veins
swelling
achiness
pain
heaviness
leg cramps
restless legs
numbness or tingling in feet
skin rash or discolored skin
ulceration or leg wound
inflammation
bleeding from your spider or varicose veins
superficial clots in your varicose veins
Choose all that apply
Which of the following improve your symptoms?
elevation
rest
compression hose
analgesics/anti-inflammatories
diurectics or fluid pills
walking
at the beginning of the day
Which of the following worsen your symptoms?
sitting
standing
working
pregnancy
menstrual cycle
lying down
walking
at the end of the day
at the beginning of the day
Which of the following treatments have you had?
compression hose
anti-inflammatories
analgesics
endovenous ablation (laser or radio frequency)
injection sclerotherapy
diuretics (fluid pills)
nothing as of this presentation
Which statement most accurately describes how your legs feel?
legs are improved by the morning and gradually become more painful
achy and fatigued as the day progresses
legs hurt more when I walk and are relieved when I sit down or stop walking and pain returns when I walk about the same distance again
legs hurt or ache more when sitting for long periods like on a car ride or plane ride
legs hurt or ache more when standing stationary for long periods of time
Does anyone in your immediate or extended family have swollen legs, varicose veins or diffuse spider veins?
Please Choose
Yes
No
If you like to upload photos, please so do here:
How did you hear about myveinscreening.com?
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Internet Search
TV
Website
Friend
My Doctor
Newspaper
Magazine
Other
If you would like to refer a friend or family member, please enter their information below.
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Accept Terms & Conditions To Proceed
I hereby release the screening physician and health care professionals from all responsibility in connection with this screening process. I understand that this is a limited screening for venous disease and does not constitute a formal medical exam or complete diagnosis.
Coastal Vein Institute physicians and health care professionals agree that no one may use or share your screening results for any purpose except for screening for venous disease. Information gathered in this screening is strictly confidential, HIPAA compliant, and is being collected for review and evaluation for the likelihood of venous insufficiency in you, the participant.
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