The Greatest Experience in Eliminating Varicose Veins

Contact The Laser Vein and Aesthetic Center BellaMD

To learn more about the EVLT laser treatment procedure for varicose veins or treatments for spider veins in Dallas, Texas, use this form to contact BellaMD or call (214) 347-8252. If you submit the form, you will be contacted shortly.

Note: * denotes a required field

Name*:

Address:

City:

State:

Zip:

Phone*:

E-Mail*:

Check any medical symptoms you are currently experiencing with your legs (check all that apply):

	Varicose (bulging) veins
	Spider veins
	Pain or tenderness
	Swelling
	Changes in skin color
	Open wounds (leg ulcers)

Are you experiencing the above symptoms in one or two legs?

	One leg
	Two legs

Have you worn compression stockings to address the above issues

	Yes
	No

If yes, how long? months

Additional Comments:
(e.g. best time or way to reach you)

For more information, call (214) 347-8252.

Bella MD
8117 Preston Road, Suite 470
Dallas, TX 75225

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