Use the test below to determine whether or not you may have venous disease. Use the following scale to choose the most appropriate number for each situation.

0 = NEVER | 1 = OCCASIONALLY | 2 = FREQUENTLY | 3 = DAILY

1. Do you experience swelling in your legs, ankles or feet?

2. Do you experience pain in your legs?

3. Do you have varicose veins?

4. Do you experience cramping in your legs or calves?

5. Do you experience restless legs at night?

6. Do you experience itching or skin changes on your legs?

7. Do you work in a profession where you are on your feet a large part of the day?

Submit

Patient Forms

New Patients or patients with a change of information: You may download the registration form and bring it with you to your visit. If you cannot view the PDF, you can download Acrobat Reader free from Adobe Systems, Inc.

Bring To Our Appointment:

Your Insurance Card
A list of Current Mediactation Including Dose and Frequency
Pertinent Ingormation About Your Medical & Surgical History

We accept Blue Cross, Blue Shield of Alabama, Medicare, United Healthcare and most major insurance plans. However, it is in your best interest to check your insurance provider’s list of participating physicians to be sure your plan allows you to be seen at our office. Also, please review with your insurance customer service representative (or insurance provider) the rules and limitations on coverage and reimbursement.

If you have billing issues or questions, please call (205) 208-0704 and we will be happy to assist you.

Contact Us in Birmingham, AL

Request an Appointment

Where We’re Located

Do I Have A Venous Disease?

Patient Forms

Bring To Our Appointment: