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 VeinsVaricose VeinsAchinessHeavinessSkin Rash or Discolored SkinBleeding From Your Spider or Varicose VeinsSwellingPainLeg CrampsNumbness or Tingling in FeetUlceration or Leg WoundInflammationSuperficial Clots in Your Varicose VeinsRestless Legs

Which of the following improve your symptoms?

ElevationCompression HoseDiurectics or Fluid PillsAt The Begining of The DayRestAnalgesics/Anti-InflammatoriesWalking

Which of the following worsen your symptoms?

SittingWorkingMenstrual CycleAt The Beginning of The DayStandingPregnancyLying DownAt The End of The Day

Which of the following treatments have you had?

Compression HoseAnalgesicsInjection SclerotherapyAnti-InflammatoriesEndovenous 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 painfulAchy and fatigued as the day progressesLegs hurt more when I walk and are relieved when I sit down or stop walkingLegs hurt or ache more when sitting for long periods like on a car ride or plane rideLegs hurt or ache more when standing stationary for long periods of timeAt the beginning of the day

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

YesNo

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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