
	Are there any cases of venous insufficiency in your family? Brother or Sister Father or Mother Both parents Parents and Siblings I don't know - None of the above
	Your body weight is: Slightly above normal Moderately above normal Significantly above normal Extremely above normal I don't know - None of the above
	Your job is: Mainly sedentary Mainly standing Always standing I don't know - None of the above
	Do you have any of the following symptoms in your legs: heaviness, swelling or pain? Occasionally Only in the evening All day Only in one leg Never
	Do your legs have any blemishes? Cellulite Small visible capillaries Some veins are in evidence Darker and redder areas near calf and ankle No, none
	Do you have burning, itching, pins and needles, heaviness and/or nocturnal cramp in your legs? Rarely Sometimes Often Almost always No, never

* Self-assessment test, without any diagnostic value.
For an accurate diagnosis, we recommend you contact your GP or a specialist in this field.