Online Vein Screening

Premier Heart and Vein Care is now able to accept online vein screenings from patients. Please fill out the below form & upload photos of your legs. Our physicians will review and reach out to you for either a virtual consultation or in-office visit.

Personal Information:

Symptoms and Past Treatments:

Varicose Veins

Spider or Blue Veins

Leg Swelling

Aching Legs

Leg Pain

Elevation

Compression

Anti-inflammatories

Rest

Compression

Diuretics

No previous treatments

Elevation

Compression

Anti-inflammatories

Pain medications

Endovenous ablation (laser, EVLT or radio-frequency)

Sclerotherapy

Vein stripping

Cauterization or suturing of a bleeding vein

Wound care, skin graft or unna boot

Additonal Information:

Drop files here

Call 805-540-3333 Or contact us below to schedule a consultation

  • * All indicated fields must be completed.
    Please include non-medical questions and correspondence only.
  • This field is for validation purposes and should be left unchanged.

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