URMC / Vein Care / Vein Evaluation Registration Vein Evaluation Registration First Name: Last Name: Address: City: State: Zip: Phone Number: ( ) - Second three digits Last four digits Email Address: Evaluation Date: Monday, May 16, 4:00 p.m. - 7:30 p.m.Thursday, May 19, 4:00 p.m. - 7:30 p.m. Chief Complaint: Please select one... Spider veins Varicose veins Ankle and leg edema Thrombophlebitis Deep vein thrombosis Chronic vein insufficiency Our Privacy Policy After submission, you will receive a call to complete your booking.