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Vascular Center of Wichita Falls

940-322-6671

Or Contact us here.

Documents

Follow-Up Post-Venous Treatment

Questionnaire to monitor progress of patients who have had treatment of veins. (Please print form, complete and bring with you for your appointment.)

Patient 6-Month to 3-Year Update

Questionnaire to update returning patient's history if it has been 6 months to 3 years since seeing Dr. Brazil. If it has been longer than 3 years since your last office visit, please complete New Patient History form. (Please print form, complete and bring with you for your appointment.)

Thoracic Outlet Syndrome Questionnaire

Questionnaire for patients who present for evaluation of possible thoracic outlet syndrome. Pain and/or numbness in arms, shoulders, neck. (Please print form, complete and bring with you for your appointment.)

Account & Insurance Information

Account and Insurance Information for reimbursement. (Please print form, complete and bring with you for your appointment.)