We must gather important information regarding your medical history and current physical condition so we can provide you with the best possible care. We also need to keep emergency contacts and insurance information up-to-date.
For your convenience, these forms are available below. Please give the completed forms to the receptionist when you check in for your scheduled appointment. If you choose not to fill the forms out before your appointment, please arrive 15 minutes early to complete the forms.
- Patient History Form
- Patient Registration Form
- Authorization for Release of Protected Health Information
The above forms all require Adobe Acrobat Reader™. Youhttps://totalveincarelouisiana.com/wp-content/uploads/2014/10/TVC-Registration-Form_FINAL.pdf may download Adobe by clicking here.
Call (225) 442-9663 or request an appointment online now.