Contact Information

Let us know how we can get in touch following your screening.

Patient Assessment Questions

Let us know about your conditions.

Patient Risk Factors

Information that helps diagnose your condition.

Photo Upload

If you have a visible condition, photos are very helpful in screening.

  • Step One
  • Step 2
  • Step 3
  • Step 4

Contact Info

Please note before you begin the screening, that this is a 100% free offer with no obligation to you whatsoever. The patient and / or any other person responsible for payment has a right to refuse to pay, cancel payment, or be reimbursed for payment for any other service, examination, or treatment or treatment that is performed as a result of and within 72 hours of responding to the advertisement for free, discounted fee, or reduced fee service, examination, or treatment.

Patient Assessment Questions

Leg Pain, aching or cramping

Burning or itching skin

Heavy feeling in legs

Visible varicose or spider veins

Leg or ankle swelling, especially later in the day

Skin discoloration or texture changes, such as above the inner ankle

Open wounds or sores, such as above the inner ankle

Restless Leg Syndrome

Risk Factors

Has anyone in your blood-related family had varicose veins?

Has anyone in your blood-related family had chronic venous insufficiency or venous reflux?

Have you had treatments or procedures for vein problems?

Do you stand for long periods, such as at work?

Do you frequently engage in heavy lifting?

Have you ever been pregnant?

Take up to three front / back photos in natural light of your condition, and then attach them here (optional).

Photo 1

Max. size: 50.0 MB

Photo 2

Max. size: 50.0 MB

Photo 3

Max. size: 50.0 MB