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Online Forms


These pre-visit forms will help you consolidate your medical history in preparation for your visit to our office. Please print the forms, fill them out by hand, and bring the forms with you when visiting our office.

Note: Completing the forms prior to your arrival will expedite the check in process. Be sure to bring your insurance card with you to your appointment, along with any outside physician referrals you may have.


Vein Center Forms


Patient Registration Packet

Notice of Privacy Practices

Pre Procedure Instructions

Endovenous Laser treatment and/or Ambulatory Phlebectomy

Sclerotherapy

Post Procedure Instructions

Ambulatory Phlebectomy Only

Endovenous Laser Treatment Only

Endovenous Laser Treatment AND Ambulatory Phlebectomy

Sclerotherapy

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The Vein and Vascular Center of Fairfax Radiology offers a comprehensive diagnosis and treatment plan for blue and purple spider veins, varicose veins, venous insufficiency as well as leg pain and cramps. Our Interventional Radiologists will provide the most appropriate diagnosis and treatment plan using venous doppler, sonogram and ultrasound, venous ablation, micro phlebectomy, sclerotherapy and VenaCure laser treatment to alleviate your discomfort and improve your appearance.

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