Click Here For NLVAC's Website Confidential Vein Screening by Comprehensive Cardiovascular Consultants
Welcome to our latest advance at making your vein evaluation and education more accessible. Our newly developed Vein Screening allows you to confidentially submit your completed vein questionnaire and photos directly over the internet to one of our board certified vein specialists specializing in the latest vein evaluations and treatments. Our physicians will review your questionnaire responses and photos and offer their feedback on whether or not you should consider a formal vein evaluation. If you find this electronic format convenient and have family or friends who you think might benefit from this eveinscreening opportunity we hope you will forward the link to them as well.

First Name *
Last Name *
Email *
Phone *

Enter Your City *
Enter Your Zip Code *
Enter Your Date Of Birth *
Name Of Insurance (If Applicable) *
What Is your main concern?
Please explain in detail
Do you experience
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Which of the following improve your symptoms?
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Which of the following worsen your symptoms?
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Which of the following treatments have you had?
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Which statement most accurately describes how your legs feel?
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Does anyone in your immediate or extended family have swollen legs, varicose veins or diffuse spider veins?
If you like to upload photos, please so do here
How did you arrive at the screening? *
Required - Please Choose
If other source, please explain
*If none - put N/A
Accept Terms & Conditions To Proceed *
 I agree 
I hereby release the screening physician and all other health care volunteers from all responsibility in connection with this screening process. I understand that this is just a screening for venous disease and does not constitute a complete or definitive diagnosis. No one may use my screening results for any purpose except for inclusion in a statistical study, without reference to or publication of any personal identifying information including name, address, phone number and email. Information gathered in this screening is strictly confidential and is being collected for review and preliminary determination of the likelihood of venous insufficiency existing in said participant.

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