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.)
Documents
Patient Preop Documentation of Venous Conservative Therapy
Questionnaire to document patient's compliance and response to conservative therapy that is required to meet insurance criteria for 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.)