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This pre-visit form will help you consolidate your medical history in preparation for your visit to our office. Please either complete this form online and print it, or print it and fill it out by hand. Please bring this form with you when visiting our office.
Note: Completing this form online WILL NOT retain any record of your personal information. It is designed solely for your convenience, to help utilize your time with us most productively. You will need to print a second copy if you want to keep a record of this information. Please print this Consent / Authorization Form. Then bring the completed form to your initial visit.
If you are visiting the office for venous evaluation please print and complete the venous questionare (online forms), and bring it to your initial visit. During the first evaluation the doctor will review your history, perform and exam and venous ultrasound (duplex). The findings on exam / duplex and of course your desires and expectations, will then dictate treatment options. Treatment will be scheduled at your convience in the near future.
 Adobe Acrobat Reader needed to view forms.
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