New Patient Forms

New Patient Forms

Form A – Registration Sheet

Form B – Medical History/Patient Questionnaire

Form C – Release of Medical Records Authorization

Form D – HIPAA Authorization

Form E – No Show Agreement

Form F – Test Results Agreement

Form G – Credit Card Form

Form H – Pregnancy Waiver

Consent Forms in English:

Ambulatory Phlebectomy

Clarivein

EVLT

Sclerotherapy

Consent Forms in Espanol:

Ambulatory Phlebectomy

Clarivein

EVLT

Sclerotherapy

Real Patient Reviews