Online Vein Assessment

Approximately 50% of women and 25% of men have a problem with leg veins. The Cosmetic Vein & Laser Center has been treating vein problems for over 20 years, utilizing the newest technology for non-invasive vein treatments. Please complete the form below to take the next step in finding the lasting solution for your vein treatment.
Have you ever been diagnosed with varicose veins?
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Have you had treatment for varicose veins?
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Do you have a family history of varicose veins/venous reflux?
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Do you have ankle swelling with prolonged standing/sitting or air travel?
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During pregnancy, did you have leg swelling or bulging leg veins?
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Please check the boxes next to any of the following leg symptoms you experience:
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Someone in our office will contact you regarding your vein assessment.
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Online Vein Assessment

Online Vein Assessment

Approximately 50% of women and 25% of men have a problem with leg veins. The Cosmetic Vein & Laser Center has been treating vein problems for over 20 years, utilizing the newest technology for non-invasive vein treatments. Please complete the form below to take the next step in finding the lasting solution for your vein treatment.
Have you ever been diagnosed with varicose veins?
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Have you had treatment for varicose veins?
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Do you have a family history of varicose veins/venous reflux?
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Do you have ankle swelling with prolonged standing/sitting or air travel?
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During pregnancy, did you have leg swelling or bulging leg veins?
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Please check the boxes next to any of the following leg symptoms you experience:
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Someone in our office will contact you regarding your vein assessment.
Full Name
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Phone Number
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Email
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