Online Vein Screening Form

Full Name (required)

Email (required)

Phone (required)

Address (required)


What is Your Main Concern?

Do you experience? (select all that apply)

 varicose veins achiness heaviness restless legs skin rash or discolored skin inflammation swelling pain leg cramps numbness or tingling in feet ulceration or leg wound bleeding from your spider or varicose veins

Which of the following improve your symptoms? (select all that apply)

 elevation compression hose diurectics or fluid pills rest anti-inflammatories walking

Which of the following worsen your symptoms? (select all that apply)

 sitting working menstrual cycle walking standing pregnancy lying down

Which of the following treatments have you had? (select all that apply)

 compression hose injection sclerotherapy nothing as of this presentation anti-inflammatories endovenous ablation (laser or radio frequency) diuretics (fluid pills)

Which statement most accurately describes how your legs feel? (select all that apply)

 legs are improved in the morning, become painful, achy or fatigued as day progresses legs hurt more when I walk and are relieved when I sit down or stop walking and pain returns when I walk about the same distance again legs hurt or ache more when sitting for long periods like on a car ride or plane ride legs hurt or ache more when standing stationary for long periods of time

Does anyone in your immediate or extended family have swollen legs, varicose veins or diffuse spider veins?

 Yes No

How did you hear about Vascular Associates? (select all that apply)

 Internet Search TV Friend My Doctor Social Media Radio Newspaper Magazine Other

Requested Appointment Date:

Preferred Appointment Time:

Like Us On Facebook


My legs feel better than I can ever remember them feeling. I don't have the heavy feeling and all the swelling I used to have. I feel like I am walking on air! Thank you for all that you have done. My life is so much better!”
Carrie S.
Dr. Shuler and Staff, you are a blessing. Thanks to you I can testify that as of today I still have my leg. You never gave up on me and for that I am forever thankful... God Bless!”
Joe B.
When my son was on the verge of losing not only his leg but his life, you were there for us, you pulled him through. There are no words, just, God bless you Dr. Shuler.”
Jeannette B.
The first day I ran, I couldn't believe my energy level and how much less pain I felt.”
Mavis N.
I recommend Dr. Shuler and his whole team for all they have done to help my husband’s injury. My husband had already been to a vascular surgeon and was told that there was nothing that could be done, that he would have to just learn to live with it. Thanks to Dr. Shuler he's almost back to his old self. I'm so glad we met you.”
Evelyn E.
If I knew that my legs were going to feel this great I would have had them treated years ago.”
William A.
I’m so pleased with the doctors and the services that I have received from Vascular Associates. I would rate them #1 for their treatment and their caring. Dr. Shuler is a very special man and really cares about each of his patients personally. Thank you so much for everything you do!”
Paulette M.
After having my procedure on my left leg, I felt so much better! I mowed my yard and my neighbor's yard in half the time as normal.”
Kinsey G.
The first night after my procedure was the best night of sleep I have had in years.”
Emma M.

Education & Videos

Contact Us

Locations & Contact

1836 Florida Ave,
Panama City, FL 32405

P: (850) 872-8510
F: (850) 872-7412

10800 Panama City Beach Pkwy, Unit #300
Panama City Beach, FL 32407

P: (850) 872-8510
F: (850) 872-7412