standard-title Appointments

Appointments

Appointment Information

We appreciate your trust in allowing us to help you resolve your leg issues. Dr. Umerani and his staff are well qualified in vein treatment and look forward to getting to know you, your lifestyle, and your needs in order to help you get the healthy results you want. We are truly committed to resolve your vein issues in less time.

Venous Health History Form

To get your schedule for a consultation, give us a call at 937.325.3830. To save time, you have the option of completing the confidential Venous Health History form below.

Sex

Have you ever experienced any of the following in your legs? (Check all that apply)

Have you ever had vein stripping surgery?

Do you take medication for pain? (e.g., Advil)

Do you elevate your legs to relieve discomfort?

Do you wear support hose as prescribed by a doctor?

Do you stand for long periods of time at work?

Do you have any problems walking?

Have you ever had any test(s) done on your veins?

Have you been diagnosed with saphenous vein reflux?

Do you experience these problems in just one, or both legs?

Do you take medication for pain (eg, advil, etc.)?