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Vascular Center of Wichita Falls

940-322-6671

Or Contact us here.

Documents

New Patient History

Categories: Patient Information & History

Questionnaire for patients seeing Dr. Brazil for the first time. The information provided here will help him in providing you the best care possible. (Please print form, complete and bring with you for your appointment.)

Carotid Questionnaire (Stroke/TIA)

Questionnaire for patients who present with symptoms of possible carotid disease. (Please print form, complete and bring with you for your appointment.)

Varicose Veins Questionnaire

Questionnaire for patients who are seeing Dr. Brazil for varicose veins and associated pain and discomfort. (Please print form, complete and bring with you for your appointment.)

Leg Arteries (PAD) Questionnaire

Questionnaire for patients who are having pain in their legs with walking or at rest. (Please print form, complete and bring with you for your appointment.)