Privates Institut
für Chirurgie München

Find us at London Bridge Plastic Surgery

54 Wimpole Street
London W1G 8YJ
United Kingdom

and

Herzogstrasse 58
80803 Munich
Germany

+44 (0) 20 7487 0900

Founded by Dr. Florian Netzer

Florian J. Netzer MD is a member of Deutsche Gefäßliga e.V.

Bayerisches Staatsministerium für Umwelt und Gesundheit

Member of Bavarian State Ministry of the Environment and Public Health

Member of Deutsche Gesellschaft Venen

Member of Deutsche Gesellschaft für Lasermedizin

Questionnaire for determining your individual vein solution

You can fill out this questionnaire for free and send it to us to determine the most appropriate vein solution.
Within 48 hours we will provide you with a sound therapeutic recommendation.
The completed questionnaire will naturally be handled according to the regulations concerning medical confidentiality.

*Required

About you

Salutation *

Surname, Given name *

Date of birth (dd.mm.yyyy) *

Height in cm *

Weight in kg *

E-Mail address *

Our service for you

If you wish for us to call you back personally, please enter your phone number here

Questions

Please answer the following questions as accurately as possible. The more questions you answer, the more accurate our vein treatment recommendation can be.

1. Has your venous disease been given a specific scientific diagnosis?

2. Are the results of a current specialist examination available, e.g. by means of DUPLEX-sonography or phlebography? If yes, please submit as much information and as detailed as possible.

3. Please describe the appearance of the afflicted legs and the localisation of the varicour veins.

4. What complaints do you have?

5. Have you already undergone vein surgery or sclerotherapy? If yes, please submit a description of your previous vein treatment as precisely as possible (e.g. sclerotherapy of the veins in the lower leg performed 3 x between 1988 and 1990).

6. Do you wear compression stockings or are your legs bandaged? Since when?

7. Have you ever had a thrombosis? If yes, how was/were it/they treated and do you still have complaints?

8. Did you or do you have superficial phlebitis?

9. Do you have an illness of the arteries, e.g. a smokers leg?

10. Are you suffering from or have you ever suffered from a varicose ulcer (leg ulcer)?

11. Do you take any medications?

12. Do you know if you have an increased or decreased blood coagulability?

13. Do you suffer from allergies or drug intolerance?

14. Please describe your occupational situation briefly. (sitting office work; salesperson; teacher; physically hard working construction worker, etc.)

15. Further remarks

54 Wimpole Street
London W1G 8YJ
United Kingdom

and

Herzogstrasse 58
80803 Munich
Germany

+44 (0) 20 7487 0900

Questionnaire for determining your individual vein solution

Frequently requested

Important Links

54 Wimpole Street London W1G 8YJ United Kingdom and Herzogstrasse 58 80803 Munich Germany

+44 (0) 20 7487 0900

Questionnaire for determining your individual vein solution

Fre­quently requested

Impor­tant Links

54 Wimpole Street
London W1G 8YJ
United Kingdom

and

Herzogstrasse 58
80803 Munich
Germany

Frequently requested

Important Links