Norman Heart and Vascular Associates (Norman)

Vein Clinic

Self Assessment

Question: Do you have a family history of vein disease?    Yes    No

Question: Do you weigh more than 250 pounds?    Yes    No

Question: Do you take over-the-counter pain medication for leg pain?    Yes    No

Question: Have you had more than two full-term pregnancies?    Yes    No

Question: Do you have varicose veins (enlarged, bulging veins)?    Yes    No

Question: Do you have spider veins (small blood vessels that are blue or red in color)?    Yes    No

Question: Do you have slow healing sores on your legs?    Yes    No

Question: Do you have skin changes/discoloration on your legs?    Yes    No

Question: Do you have discomfort/heaviness/fatigue/pain in your legs?    Yes    No

Question: Do you have swelling in your legs/ankles/feet?    Yes    No

Question: Do you currently wear comprehension/support stocking?    Yes    No