Quiz - Alliance Orthopedics

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You’re In The Right Place

Welcome to the Vein Health Assessment

Let’s take a closer look at you—and your legs! This quick quiz will help us understand your specific symptoms and needs.

What is your gender?

Male

Female

Which of the following symptoms are you experiencing?

Swelling in the Legs or Ankles

Heaviness or fatigue in the legs

Changes in skin color or texture

Burning or itching sensations in the legs

Leg cramping or aching

Restlessness in the legs

Sores or open wounds that won’t heal

Difficulty with leg movement

Visible veins (e.g., spider veins, varicose veins)

None Of The Above

How long have you been experiencing these unwanted symptoms?*

0-6 Months

6-12 Months

1-2 Years

2-5 Years

5+ Years

10+ Years

Something you need to know…

One in 3 adults experiences symptoms of vein-related issues, such as swelling, aching, or varicose veins. The good news? Effective treatments are available and often covered by insurance.

How would you describe the impact of your symptoms on your daily life?*

No impact

Mild impact (e.g., occasional discomfort)

Moderate impact (e.g., frequent discomfort or difficulty)

Significant impact (e.g., affecting mobility or daily activities)

What steps have you taken to address these symptoms?*

Consulted with a vein specialist

Wore compression stockings

Used vein cream or topical treatments

Increased physical activity or exercise

Adjusted diet or lifestyle habits

Discussed with my primary care physician

Tried home remedies

Laser therapy

Other

I have not taken any steps

Have the steps you’ve taken improved your symptoms?*

Yes, significantly

Somewhat

Not at all

Real Patients, Real Results

"Since addressing my chronic leg pain at Alliance Orthopedics, I’ve noticed a huge difference in how I feel every day. The heaviness and discomfort in my legs are gone, and I have so much more energy. It’s incredible to feel like myself again—healthy, confident, and ready to take on anything!"

- Samantha, New Jersey

Are you looking to solve this problem permanently?*

Yes

What type of insurance do you carry?*

PPO (Preferred Provider)

HMO (Health Maintenance)

Medicare

Medicaid

Other

None

Based on your results,

You may be showing signs of vein disease.

Please enter your information below for a member of Alliance Orthopedics to contact you to see a vein specialist.

Name*

First Last

Phone*

Birthday

MM slash DD slash YYYY

Email*