Do your legs ever feel unusually tired or heavy, even if you haven’t done much physical activity? *

Yes, often or sometimes

No, rarely or never

Do you experience leg cramps during the day or a "restless" feeling in your legs at night? *

Yes, frequently or occasionally

No, rarely or never

Do your shoes or socks leave indentations on your skin or do you notice ankle swelling? *

Yes, frequently or sometimes

No, rarely or never

Have you noticed small, thin veins appearing on your legs that look like a web or branches? (Spider veins can be an early sign of circulation issues.) *

Yes, or possibly

No, not that I’ve noticed

Have you ever had a wound, or sore that took a long time to heal? *

Yes, I have

No, never or not that I remember

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Full Name *

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