Since how long have you been suffering with this problem ? WeeksMonthsYears
Which part of your foot affected? entire legBoth lowerlimbs
Is there any pain in the legs? YesNoOccasionally
Is the pain is more after exertions or standing long? YesNoOccasionally
Is the pain more towards the evening or night? YesNoOccasionally
Is the pain better when you keep the foot elevated? YesNoOccasionally
Is the pain better with bandaging or pressure YesNoOccasionally
Is there any bleeding from the varicose veins? YesNoOccasionally
Is there affected part black or discolored? YesNOOccasionally
Is the pain better when you use stockings? YesNoOccassionally
Is there any family history of varicose veins? YesNoNot sure
Have you got any investigations like a dopler done? (If yes, then please mention the details of the report in the ‘more symptoms’ column at the end of the questionnaire)YesNo
Are you already a patient with Dr.Manoj's Homeopathy? If yes then please state your Registration Number. in the more symptoms column.YesNo
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