1. { binding displayValue, mode=oneTime }

Spider veins are typically known as the small surface, often-blue veins. Varicose veins are the larger, bulging, referred to as “ropey” veins, which are typically just beneath the skin’s surface.

Have you ever had spider veins? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Have you ever had varicose veins? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Signs and Symptoms 

Do you experience or suffer from any of the following signs or symptoms in your legs?   {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Risk Factors

Has anyone in your blood-related family ever had varicose veins or been diagnosed with venous disease? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Do you stand for prolonged periods of time? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you had any treatments or procedures for vein problems? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{# pageNumbers}
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{# pageNumbers}

Spider veins are typically known as the small surface, often-blue veins. Varicose veins are the larger, bulging, referred to as “ropey” veins, which are typically just beneath the skin’s surface.

Have you ever had spider veins? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you ever had varicose veins? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Signs and Symptoms 

Do you experience or suffer from any of the following signs or symptoms in your legs?   {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Risk Factors

Has anyone in your blood-related family ever had varicose veins or been diagnosed with venous disease? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Do you stand for prolonged periods of time? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you had any treatments or procedures for vein problems? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
How Did you Hear About Us? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }