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Insurance Questionnaire
Most insurances cover vein treatments if all of the following therapies have been tried. Have you tried the following?
Prescription compression stocking use
Yes
No
Increased physical activities such as exercise or walking
Yes
No
Leg elevation
Yes
No
Over-the-counter pain medicines
Yes
No
Most insurances cover vein treatments if you still experience symptoms despite trying other therapies. What symptoms are you currently experiencing?
Tired, achy, throbbing, painful legs
Yes
No
Leg cramps or restless legs
Yes
No
Foot pain, tingling, numbness or burning
Yes
No
Leg swelling or heaviness
Yes
No
Itching, bleeding, or skin sores
Yes
No
Low energy or poor sleep
Yes
No
Most insurances cover vein treatments if your leg symptoms are causing limitations with activities. Which of these activities do you experience limitations with currently?
Sitting, standing, or riding for long periods
Yes
No
Shopping, housekeeping, home duties
Yes
No
Taking care of yourself, children, or family
Yes
No
Exercise, walking or maintaining an active lifestyle
Yes
No
Job performance duties
Yes
No
Trouble sleeping
Yes
No
Needing to rest and elevate legs in a recliner or sofa due to discomfort
Yes
No
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