The veins I'm concerned about are:On one leg or footOn both legs or feetOn my faceSomewhere else

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Question 1 of 8

The way my veins look affects the kind of clothes I choose to wear:Yes, it doesNo, it doesn't

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My veins have now been troubling me for:Less than 1 year1-2 yearsOver 2 years

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Question 2 of 8

Thinking about the last two weeks, please select ALL that apply to you:My veins have itched or achedMy veins have affected how I socialise or spend my free time (including sports and hobbies)I have worn support tights or stockings

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I have sought treatment before:Yes, laser treatmentYes, other treatmentNo, I haven't

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Question 3 of 8

Choose the one that matches your symptoms best:Veins are red or purple, small, and spider-like. Occasionally painful.Longer or larger purple veins: looking more like ropes. They might bulge out.Blue and red veins with some swelling of the leg, ankle or foot.Blue and red veins, with swelling and some discolouration of the skin.Painful, itchy leg ulcers that do not heal easily.

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My veins are:RedPurpleA different colour

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Question 4 of 8

My veins have now been troubling me for:Less than 1 year1-2 yearsOver 2 years

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Select all that apply. My veins have affected:My self-confidence when it comes to relationships and / or workMy physical wellbeing

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Question 5 of 8

I am concerned about the consequences of long-lasting vein disease:Yes, I amNo, I'm not

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Question 6 of 8

I am concerned about the risks of chronic vein disease:Yes, I amNo, I'm not

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Question 7 of 8

I have previously been diagnosed with Deep Vein Thrombosis (DVT):Yes, I haveNo, I haven't

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Question 8 of 8

I have sought treatment before:Yes, I haveNo, I haven't

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Thank you.

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