RESULTS OF SUPPORT STOCKING TRIAL

Results of Support Stocking Trial

Today's Date*
Date of Initial Visit*
Weeks Since Last Visit
Name*
First Middle Last Suffix
Date of Birth*
Age
Email*
Enter Email Confirm Email
I have worn the support stockings:*
- Yes
- No
Elaborate Your Wearing of Support Stockings, if Necessary
I have taken pain medications*
- Yes
- No
Type of pain medications
Relief with support stockings:*
- Complete
- Partial
- No relief
Elaborate Relief with Support Stockings, if necessary.

Alyeska Vascular Surgery • 4001 Laurel Street, Suite 204 • Anchorage, AK 99508

Phone: 907-562-8346 • Fax: 907-562-8347