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Our Team
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Varicose Veins
Vascular Diagnosis
Diabetic Feet
Laser Treatment
Carotid Artery Disease (CAD)
Lymphedema Treatment
Deep Venous Thrombosis (DVT)
Pelvic Venous Congestion
Dialysis Access
Peripheral Arterial Disease (PAD)
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Varicose Vein Recovery Tracker
Varicose Vein Recovery Tracker
CVVAdmin
2024-12-14T20:14:58-04:00
Patient Information
First Name:
Last Name:
Contact Email:
Contact Phone:
Today's Date:
Date of Last Operation:
Medical Information
Doctor:
--Select--
Dr. Dale Maharaj
Not seen a doctor yet
Other
Specify Doctor:
Surgery Type:
--Select--
Laser Treatment
Sclerotherapy
Vein Stripping
Ambulatory Phlebectomy
Endovenous Thermal Ablation
Compression Therapy
HASTI Symptoms
Heaviness:
(Feeling of heaviness in the legs)
3
Low
High
Achiness:
(Persistent dull pain or discomfort)
3
Low
High
Swelling:
(Visible or physical swelling in the legs)
3
Low
High
Throbbing:
(Rhythmic pulsating sensation)
3
Low
High
Itching:
(Irritation or itching in the affected area)
3
Low
High
Additional Information
Upload an image of the affected area:
Would you like to be contacted?
--Select--
Yes, I would like a consultation
Yes, I need immediate attention
No, Just updating my diary
Submit
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