Patient Forms & Guidelines

Get a head start so we can get started quickly.

We want to get to know you better. New patients must complete a few short forms, and we encourage you to print and fill them out ahead of time. It’s also helpful to come in ready to ask any questions so that you’ll leave our clinic armed with the knowledge you’ll need to make informed decisions.

Patient History

We ask you about your symptoms and lifestyle so we can better understand your specific condition, concerns and goals. We also ask about your general health, medications and allergies.

Patient History Form (2 pages)

Notice of Privacy Practices

This is an official notice of your rights as a patient and our responsibilities to maintain your privacy. We just need your signature acknowledging we have given you a copy of this document.

Notice of Privacy Practices (8 pages)

Office Policies

This outlines our office and financial policies and ways you can pay. Our insurance experts and administrative team will walk you through it during your visit to help you better understand all the details.

Office Policies (1 page)

Authorization for Communication

We ask basic information about the best way to contact you and your family over the course of your treatment.

Authorization Form (1 page)

Patient Form

We ask basic information about you and your other physicians.

Patient Form (1 page)

Health & Safety Policies

To reduce the risk of exposure and spread of COVID-19 Vein Clinics of America has enhanced safety protocols in place.

View Health & Safety Policies