GUADALAJARA VEINS PHYSICIAN

Will you be traveling and participating in this service learning trip with any friends or family? Please note, the minimum age to volunteer is 14 years old.

Yes

No

Are you a new or returning participant?*

Novice - this will be my first trip

I have been once before

I have been two or more times

Do you speak Spanish?

No

I am proficient in medical spanish

I am fluent in spanish

Can you perform lower extremity vein mapping?

Yes

No

Can you perform DVT exams?

Yes

No

Do you have a portable ultrasound to bring with you to Honduras?

Yes

No

Do you perform ultrasound guided foam sclerotherapy in your practice?

Yes

No

Do you have experience with using MOCA (ClariVein) in your practice?

Yes

No

Do you currently practice Phlebology?

Yes

No

Do you do your own ultrasound evaluations?

Yes

No

ENCUESTA PREVIA A LA BRIGADA DE PROLOTERAPIA