Do you have a family history of vein disease?

Yes

Do you stand all day? *

Yes

Do you have any visual veins on your legs? *

Bulging varicose veins

Spider veins

Cluster of veins on legs

None

Your score for vein disease

Any score about 2-3 may indicate that you may have an underline condition called chronic venous insufficiency.

Full Name

Phone *

Email *

Preferred Location? *

Are you a new or existing patient? *

New patient

Existing patient

When would you like to come in? *

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