Contact Vein Institute of Connecticut

Contact Us

Name*
Address
City
State
Zip
Phone*
E-Mail*

Check any medical symptoms you are currently experiencing with your legs (check all that apply):
Varicose (bulging) veins Spider veins Pain or tenderness Swelling Changes in skin color Open wounds (leg ulcers)

Are you experiencing the above symptoms in one or two legs?
One leg Two legs

Have you worn compression stockings to address the above issues
Yes No
If yes, how long?	months

Additional Comments (e.g. best time or way to reach you)