Total Vein Care : Forms

Contact Us

201 East Huron Street
Suite 11-250
Chicago, Illinois 60611
(312) 649-6562
Fax: 312-649-9027

Please contact our office with other questions that you may have. Your query will be routed to the appropriate staff member.

For medical emergencies only, page Dr. Vazquez at 312-893-2401 (all medical emergencies should proceed to nearest emergency room.)

PATIENT FORMS

> Registration Form

> Patient Medical History Form

> Financial Responsibility Form

> HIPPA Policies regarding medical information

> Phlebology Questionnaire

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