Studies routinely report a prevalence of venous disease of twenty percent or higher among western industrialized countries, and it is predicted that numbers will rise even higher in industrialized and obese populations. Whether patients present with cosmetic concerns, chronic pain, or complications of chronic venous insufficiency, there is a broad opportunity to deliver their desired outcomes. Advances in duplex ultrasound evaluation and minimally invasive surgical techniques have allowed phlebologists to effectively manage venous disease in medical offices and vein centres rather than traditional hospitals. These specialized outpatient settings are more representative of a cosmetic surgery or dermatology practice, designed to optimize the patient experience. Physicians performing endovenous procedures in the typical hospital environment often meet obstacles that limit their efficiency. The purpose of this manual is to provide a practical and effective framework for transitioning an existing hospital based practice to the outpatient arena. Some of the questions tackled by this manual include: # Where can I acquire the necessary training and education? # What equipment is required, and where might I find it? # What are my start-up costs, and will I need a loan? # What personnel are needed, and how do I identify the best candidates? # What is the best way to market my practice? How much will I spend and how effective will a campaign be? # How do insurers view procedures for varicose veins? How will I get paid? These questions and many more are outlined in detail and examples are given, helping the reader in a very practical way to take steps towards creating a successful office-based phlebology practice. There are many ways to develop and manage a practice and the authors recognize that not all strategies work in all markets. Despite differences from country to country, this text shares sound principles that, when implemented, should enhance an existing system, and help to improve patient outcomes.