Optimale Krampfaderbehandlung mit individuellem Fragebogen ermitteln

London Bridge Plastic Surgery & Aesthetic Clinic

54 Wimpole St.
London W1G 8YJ | UK

Fon +44 (0) 20 7487 0900
info@remove-veins.co.uk

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Dr. Netzer explains the function of Veins

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Fill online questionnaire here.

Step 1 / 6

Name*

Email*

Date of birth*

Heigth in cm*

Weight in kg*

Health inssurance

2/6

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.

3/6

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?

4/6

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)?

5/6

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?

6/6

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

15. Further remarks

I agree that my details from the contact form will be collected and processed to answer my request. The data will be deleted after the processing of your request. Note: You can revoke your consent at any time for the future by e-mail to ordination@venenfrei.de. Detailed information on handling user data can be found in our privacy policy.

Partner:

Member:

• In the competence network of the Bavarian Ministry of Health
• The German Society veins
• The German Society for Laser Medicine
• The German Vessel League

Legals:

Impresssum

Anschrift	Herzogstrasse 58 D-80803 München
Telefon	089 - 24 24 34 38
Fax	089 - 24 24 34 39
Email	ordination@venenfrei.com

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