• SecondsCount Venous Disease Risk Assessment Checklist

     
     
    3/03/2013

    Are you at risk for problems with your veins? Check off the items that apply and share your answers with your doctor. Together you can find ways to reduce your risk of developing problems in the future.

    Check the box if you:

    [ ] have family history of vein problems

    [ ] are older, especially over age 70

    [ ] are overweight

    [ ] are pregnant or recently had a baby

    [ ] have had or are experiencing hormonal changes, for example, pregnancy or menopause

    [ ] use estrogen or oral contraception

    [ ] stand, sit, or stay in bed for long periods of time

    [ ] have a prior history of blood clots

    [ ] have been injured

    [ ] have been ill

    [ ] have been in the hospital or intensive care unit

    [ ] have recently had surgery or treatment for cancer

    [ ] smoke

    [ ] have had too much exposure to the sun

    [ ] do not exercise

    [ ] go too long without water

    [ ] have had an infection

    [ ] have had congestive heart failure

    [ ] have varicose veins

    [ ] have inflammatory bowel disease

     

    Please feel free to print the SecondsCount Venous Disease Risk Assessment Checklist here. (PDF)