Ask a Question / Request a Free Screening
Midwest Vein & Laser is dedicated to providing our patients with the best possible care and personal attention. We consult with every potential patient individually, at no charge, so we can tailor treatment to their specific needs.
In-person consultations are done at our Dayton, Ohio office location. Please use the form below to request a time that is convenient for you.
We also can answer you questions by email. Please submit your question on the adjacent form
Patients can alternatively call our offices directly at:
These are fill-able forms below (you can type in the information). The Firefox browser does not always work with fill-able PDF's. Please try Chrome, or Internet Explorer. If you're on a MAC, Safari should also work.
Download Patient Form HERE
Download Uterine Fibroid Patient Form HERE
*** DO NOT EDIT THE FORM INSIDE YOUR BROWSER - DOWNLOAD TO YOUR COMPUTER AND REOPEN THE FORM - IF YOU EDIT THE FORM INSIDE YOUR BROWSER AND THEN SAVE IT, YOUR DATA MAY NOT BE SAVED (YOU'LL END UP WITH A BLANK FORM).***