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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* 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?

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* 5. What is your gender?

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

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