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Have you ever been diagnosed with varicose veins?
- Yes
- No
Have you had treatment for varicose veins?
- Yes
- No
Do you have a family history of varicose veins/venous reflux?
- Yes
- No
Do you have ankle swelling with prolonged standing/sitting or air travel?
- Yes
- No
During pregnancy, did you have leg swelling or bulging leg veins?
- Yes
- No
Please check the boxes next to any of the following leg symptoms you experience:
- Pain
- Achiness
- Swelling
- Bulging Veins
- Cramping
- Heaviness
- Burning or itching
- Skin discoloration or texture changes
- Restlessness
- Open wounds or sores
Someone in our office will contact you regarding your vein assessment.
Full Name*
Phone Number*
Email*
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

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Have you ever been diagnosed with varicose veins?
- Yes
- No
Have you had treatment for varicose veins?
- Yes
- No
Do you have a family history of varicose veins/venous reflux?
- Yes
- No
Do you have ankle swelling with prolonged standing/sitting or air travel?
- Yes
- No
During pregnancy, did you have leg swelling or bulging leg veins?
- Yes
- No
Please check the boxes next to any of the following leg symptoms you experience:
- Pain
- Achiness
- Swelling
- Bulging Veins
- Cramping
- Heaviness
- Burning or itching
- Skin discoloration or texture changes
- Restlessness
- Open wounds or sores
Someone in our office will contact you regarding your vein assessment.
Full Name*
Phone Number*
Email*
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Δ

North Texas Endovascular

870 International Pkwy, Suite 200
Flower Mound, TX 75022

Phone:

Contact Us

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