--- title: Vein Self Assessment Form description: This survey may help determine if you can benefit from our treatment services. --- [![VINJ_TCVC-Logo.jpg](https://health.veininstitutenj.com/hs-fs/hubfs/New-VINJ_Logo.png?width=350&height=71&name=New-VINJ_Logo.png "VINJ_TCVC-Logo.jpg")](https://www.veininstitutenj.com) [973-539-6900](tel:9735396900) - [home](http://veininstitutenj.com/) - [contact](http://veininstitutenj.com/contact/) - [Facebook](https://www.facebook.com/Vein-Institute-of-New-Jersey-194043250629023/) - [Instagram](https://www.instagram.com/veininstituteofnj/) - [Careers](https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=01ac20b2-794f-4cd2-b641-85102eaee82c&ccId=19000101_000001&lang=en_US&selectedMenuKey=CareerCenter) - [Patient Portal](https://gateway.aprima.com/portal/home/11101) - [Home](http://veininstitutenj.com/) - [Appointments](http://veininstitutenj.com/appointments/) - [Locations](https://www.veininstitutenj.com/appointments/locations/) - 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[Facebook](https://www.facebook.com/veininstitutenj) - [Instagram](https://www.instagram.com/veininstituteofnj/) # Are You a Candidate for Vein Treatment? ### **Try this Self-Assessment Survey** ## What do your answers mean? If you answered YES to any of the questions or checked any of the symptoms boxes in this survey, you may be a candidate for vein treatment. Provide us with your contact info and someone will get back to you discuss your survey responses. Or, if you would like to schedule an appointment with one of our board-certified physicians right away, please click below: [![Schedule Your Appointment Today](https://no-cache.hubspot.com/cta/default/3952114/95cba5d3-992a-48c1-bd3f-a7d7684c35dc.png)](https://cta-redirect.hubspot.com/cta/redirect/3952114/95cba5d3-992a-48c1-bd3f-a7d7684c35dc) ![iStock-861883446-552491-edited](https://health.veininstitutenj.com/hs-fs/hubfs/Blog%20Images/iStock-861883446-552491-edited.jpg?width=1414&name=iStock-861883446-552491-edited.jpg)   ©2026, Vein Institute of New Jersey. All Rights Reserved. [Privacy Policy](http://veininstitutenj.com/privacy-policy/)