Virtual Vein Questionnaire

Thank you for choosing to take an online screening with Virtual Vitality Vein Care.  Please answer the questions below, take a picture of your area(s) of concern and submit this form.  Once submitted, a vein specialist from VVC will contact you no later than the next business day.

  • Note: It IS possible to have vein disease without obvious, visible changes. If you do not have visible signs of vein disease submit your information without a picture.
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