Thank you for choosing the Center for Vascular Medicine. You will find links below to our new patient forms and patient handbooks. Our staff is committed to the long-term treatment, monitoring and prevention of pelvic and lower extremity vascular diseases, most of which are chronic but treatable. For those who meet our indications for treatment, we do our utmost to provide immediate interventional care to relieve symptoms. Center for Vascular Medicine takes pride in offering the most advanced and patient-focused diagnostic and therapeutic modalities. Our practice is rooted in the following words “A customer is the most important visitor on our premises. They are not dependent on us. We are dependent on them. They are not an interruption in our work. They are the purpose of it. They are not an outsider to our business. They are a part of it. We are not doing them a favor by serving them. They are doing us a favor by giving us an opportunity to do so.”

New Patient Resources

Please use the links below to download our new patient forms and patient handbooks. We ask that you complete the forms prior to your first visit to help expedite the registration process.

Included in the New Patient Forms

  • Patient Demographics Form - Basic contact, primary care physician, and insurance information need to be recorded.
  • Medical Information Form - Medical history, allergies (food/medication), and current symptoms need to be recorded.
  • Consent for Disclosure of Protected Health Information - Other parties (e.g. family) who you would like to give access to your medical records will need to be listed here. We will share your information with other providers only when it is deemed necessary for your continuum of care.

Please also bring the following documents to your first visit so we can make copies for our records:

Photo ID
and/or
Driver’s License

Insurance
Card

Referral
if one was provided to you by your primary care physician

  • A photo ID such as a Driver’s License, State ID, Military ID, etc.
  • Your current insurance cards
  • Your referral slip from your Primary Care Physician (if required by your insurance plan). If your plan requires one, and one is not provided by the day of your visit, we will not be able to see you.

If you have any questions, please call our office at (301) 486-4690.