Lafayette Regional Vein Center - Indiana

Forms for Patients

Speed Up Your Visit!

$75 Coupon off of Cosmetic Spider Vein treatment

Just mention this special web offer to be eligible to receive a $75 discount on a cosmetic sclerotherapy session. Call today!

The Lafayette Regional Vein Center understands there is a lot of paper work associated with medical treatment. That is why they have included the following resources to conveniently speed up the administration process.

Patient History Form

Download the DOC File: Patient Health and History Form.5.26.2009.doc

Patient Information Form

Download the DOC File: ADMIN.PATIENT.Information.doc

Janie S.Should your legs feel older than you are?
“After treatment the aching goes away, and your legs feel as they did when you were younger!”