Vein Screening SurveyStep 1: Complete 3 Minute Vein Screening and hit “Send” at the bottom of the page.Step 2: A RejuVeination team member will call you within 48 hours (2 business days) to discuss your vein screening results. If we miss you, a detailed email will be sent providing you with your results.Have you ever had spider veins?Spider veins are typically known as the small surface, often-blue veins. Varicose veins are the larger, bulging, referred to as “ropey” veins, which are typically just beneath the skin’s surface.Have you ever had spider veins?YesNoHave you ever had varicose veins?Have you ever had varicose veins?YesNoSigns and SymptomsDo you experience or suffer from any of the following signs or symptoms in your legs? Leg Heaviness or Fatigue Restless Legs Itching or Burning of the Skin Leg or Ankle Swelling Leg Pain, Aching, Cramping or Throbbing Skin Discoloration or Texture Change Open Wounds, Sores or Venous UlcersRisk FactorsHas anyone in your blood-related family ever had varicose veins or been diagnosed with venous disease?YesNoDo you stand for prolonged periods of time?Do you stand for prolonged periods of time?YesNoHave you had any treatments or procedures for vein problems?Have you had any treatments or procedures for vein problems?YesNoContact InformationYesFullName*Mobile*Email* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How did you hear about us?Click send to submitLocationCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.