Please fill out the form below and a vascular specialist will review and make an evaluation of your venous concerns. A specialist will contact you after receiving your screening to discuss your results. Thank you and we look forward to helping you feel & look happier and healthier.

General Information

Address

Do you experience?

 Spider Veins Varicose Veins Achiness Heaviness Skin Rash or Discolored Skin Bleeding From Your Spider or Varicose Veins Swelling Pain Leg Cramps Numbness or Tingling in Feet Ulceration or Leg Wound Inflammation Superficial Clots in Your Varicose Veins Restless Legs

Which of the following improve your symptoms?

 Elevation Compression Hose Diurectics or Fluid Pills At The Begining of The Day Rest Analgesics/Anti-Inflammatories Walking

Which of the following worsen your symptoms?

 Sitting Working Menstrual Cycle At The Beginning of The Day Standing Pregnancy Lying Down At The End of The Day

Which of the following treatments have you had?

 Compression Hose Analgesics Injection Sclerotherapy Anti-Inflammatories Endovenous Ablation (laser or radio frequency) Diuretics (fluid pills) Nothing as of This Screening

Which statement most accurately describes how your legs feel?

 Legs are improved by the morning and gradually become more painful Achy and fatigued as the day progresses Legs hurt more when I walk and are relieved when I sit down or stop walking Legs hurt or ache more when sitting for long periods like on a car ride or plane ride Legs hurt or ache more when standing stationary for long periods of time At the beginning of the day

Does anyone in your immediate or extended family have swollen legs, varicose veins or diffuse spider veins?

 Yes No

Please upload an image of your problem areas

Dr. Leary took a lot of time with me and was very detailed. He walked me through what causes the symptoms. He went through the different options to fix to the problem and suggested the best solution for me. He did a great job of managing my expectations. He has ...
Karen
I had large, bulbous veins on the front of the my legs where they were very noticeable. I like to wear shorts and I’m very athletic . I run, I go to the gym and the vein was right in front where I would always see it.I liked the idea ...
Denise
I am so pleased with how my legs look and feel! Over the past 20 years, I have had various types of treatments in several cities for my varicose veins, and Dr. Leary is the best. Never have I seen such noticeable improvement in such little time. Dr. Leary and ...
Collie
I have to tell you again that I’m absolutely thrilled with the work that Dr. Leary has done – I’ve had 4-5 sclerotherapy appointments with him and it’s been terrific. The difference is amazing – I’m definitely ready for summer! When I was in this morning I told him that ...
Alicia

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