Treatment by compression sclerotherapy for varicose and telangiectatic leg veins has become more accepted in the United States within the past decade. Aided by certain advances, such as less toxic synthetic sclerosing solutions (sodium tetradecyl sulfate), prolonged compression, and more accurate methods of detection of high venous pressure by Doppler ultrasound, sclerotherapy achieves greater efficacy with less morbidity. Evaluation of the patient with varicosities begins with a complete history. With the patient’s legs entirely exposed, visual inspection and palpation are the first steps in presclerotherapy evaluation. A diagram of the visual varicosities and telangiectasias is made on a standard form with notation of bulges and fascial defects. Although there is no substitute for sound clinical judgment, recommendations for which patients require Doppler examination are made. Once proper diagnosis occurs, the practitioner can treat as many veins as possible in a given period of time by a logical treatment sequence of injecting venous “regions” or entire abnormal superficial venous networks related to incompetent perforators.