DOC Vein Management

Email Address *

First Name *

Last Name *

Phone Number *

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Have you ever had spider veins? *

Spider veins are small blue veins below the surface of the skin that you can see, but cannot feel.

Have you ever had varicose veins? *

Varicose veins are similar to spider veins, but they are larger veins that you can see and feel.

Have you been treated for vein issues before? *

Have you ever been pregnant? *

Do you have a family history of venous disease? *

Does your job require prolonged sitting? *

Does your job require prolonged standing? *

Do you exercises regularly? *

Walking, lifting, aerobics, etc. at least 30 mins, 5+ days a week

Free Vein Screening