Patient Forms & Information

Getting To Know You

First and foremost we care about your health. As part of providing you the very best care, we need to ask you to provide standard health information to have with you at your first appointment. We encourage you to print and fill these forms out ahead of time. This speeds up your time at our office and also allows you time to think about any questions you may want to ask us.

New Patient Forms

These forms and guidelines are essential in getting you the best and most effective treatment.

Please click on the links below, print them on your printer, and complete the forms with the requested information. You will need a PDF reader such as Adobe Acrobat to open the files.

Triangle Vein Clinic Form Descriptions

Patient Registration

This is your basic contact information, primary care provider and insurance. This helps set you up as a Triangle Vein Clinic patient.

Patient Registration (1page)
TVC Questionnaire

These are questions about your legs, varicose veins, different symptoms, and possible causes.

TVC Questionnaire (1page)
Review of Systems

This provides the doctor information about any symptoms or issues related to your general health.

Review of Systems (1page)
Policies & Procedures

We ask you to read and sign this document which outlines your rights and Triangle Vein Clinic policies.

Policies and Procedures (2 pages)
Health History

This outlines your medical history, allergies, family, social habits, etc. to help us determine concerns and goals.

Patient Health History (2 pages)
Referral Sources

This lets us know how you found us and to measure the effectiveness of our marketing.

Referral Sources (1page)
Health Release Info

Authorization for communicating with you, your physicians, and your family while being treated.

Release of Health Information (1page)