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

CathyHer veins couldn't keep her down.
“I play golf and I wear shorts. I knew they wouldn't go away on their own. The results are wonderful and its not a very invasive procedure.”