Vein Survey

Step 2: Free Online Vein Assessment

Finish this quick ONE MINUTE assessment that can help you identify potential Vein Disease Symptoms.

Determine if you are at RISK of developing Vein Disease then get a Free Vein Consultation at our nearest clinic in your area.

1. To get started, please verify your 5-digit zip code: *

2. OK, great! Let's get started...What's your Date of Birth?

3. Gender

Female

Male

4. Do your veins exhibit any of the following characteristics?

Large, bulging veins on your legs

Swollen, red or warm to the touch

Skin discoloration or texture changes

None

5. 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

Sores or skin ulcers near ankle

Tender areas around veins

Swelling

None

6. Which image below looks closest to your legs?

Spider Veins

Varicose Veins

Legs Ulcers

No Visible Issues

7. If you are a candidate for vein treatment, how ready are you to get relief and clear up those vein issues?

Yes, I am ready to schedule my free vein consultation

Not sure - I have some questions.

I do not want to fix my vein problem.

Not sure- I have some questions

Payment for treatment

I have insurance

I have no insurance

Cherry financing

I'll pay cash

CareCredit

Please write your insurance from the list below. if you cannot find your insurance in the list, please write it above (then click next)

Please provide the following we'll use this to schedule your Free appointment

13. First Name *

14. Last Name *

15. Confirm your best email address: *

16. Active mobile number: *

I agree to receive marketing messaging from Vein Health Clinics in Winter Haven at the phone number provided above. I understand I could frequently receive messages, data rates may apply, and reply STOP to opt-out.

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⭐️⭐️⭐️⭐️⭐️

Awesome place ! The medical professionals are awesome and so kind ! Everything was professional , my exam took a little longer but the service really worths it!

-Kizito Lotanna Mbaekwe

⭐️⭐️⭐️⭐️⭐️

they treated me good the staff is also very nice and pleasant never had an issue and they paid for Uber to pick me up and drop me off can't say nothing but good things about these people

-Donald Roth Sr.

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