Vein Patient Outreach Survey

Thank you for participating with the American Venous Forum's Vein Patient Outreach Survey.

The AVF is committed to promoting venous and lymphatic health through education and disease awareness. As someone who has experienced, or is currently experiencing, leg symptoms or venous disease, your answers to these survey questions will help us provide the information that patients are looking for, where they are looking for it.

This survey shouldn't take you more than 5 minutes to complete.

While your responses will be completely anonymous, we would greatly appreciate it if you would answer a few demographic questions first. Thank you again!

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* 1. In what country do you live?

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* 2. In what state or province do you live?

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* 3. In what ZIP code or postal code do you live?

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* 4. What is your age?

Under 18

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

I'd prefer not to answer

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* 5. What is your gender?

Female

Male

I'd prefer not to answer

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* 6. What is your ethnicity? (Please select all that apply.)

American Indian or Alaskan Native

Asian or Pacific Islander

Black or African American

Hispanic or Latino

White / Caucasian

Prefer not to answer

Other (please specify)