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Intake Forms
Please print, fill out and bring with you on the first visit:
Patient Registration Form
Patient Registration Form (Spanish version)
Health Questionarre
HIPAA Form
Insurance Information and Financial Policy Form
NOTICE AND ACKNOWLEDGMENT OF RECEIPT AND UNDERSTANDING
California Vascular & Vein Center Spanish Version
AUTHORIZATION TO RELEASE HEALTHCARE INFORMATION
Address
177 E Houston St
New York, NY 10002
Phone
+(888) 695-9859
+(888) 569-9859
Email
info@example.com
hello@example.com
Book Your Appointment
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Milpitas02
995 Montague Expy 213, 2nd floor Milpitas, CA 95035
Tel: (408) 708-4153
Fax No : 408-889-6150
Hours:
Monday to Wednesday:
9 AM to 4 pm
Bakersfield 01
2808 F Street, Suite A
Bakersfield, CA 93301
Tel: (661) 873-4216
Fax: 661-873-4216
Hours:
8 am to 4 pm weekdays
8 am to 1 pm on Saturdays
Sunday closed