For New Patients

At VITA Veins, all patients can expect to receive the highest quality of care and technical expertise. Our minimally invasive vein treatment therapies are tailored for today's busy lifestyle, allowing you to return to normal activities the same day. Receive stunning results with a 45 minute in-office procedure, minimal recovery time, and little to no scarring. Experience life without the pain and embarrassment of varicose veins or spider veins!

Complete the form below, which includes the demographics and health history portion of your new patient paperwork.

New Patient Information

Health History Information

Please select all that apply

Family History

If you have a family history of any of the following, select which family member from the drop down list.

Social History

Surgical History

Please list all surgeries and the year they were preformed.

Current Medications

Please list ALL current medications.