I'm under the age of 18 years old and I confirm my parent(s) or personal representative consent my intention to have a treatment at USA Vascular Centers

By submitting this form, I give USA Vascular Centers consent to contact me via email, at any phone numbers I provided, including mobile numbers, via an automated dialing system in regard to my request for information and any future services rendered. I understand that my consent is not a requirement for services from USA Vascular Centers.