Forms for Your Visit

The forms below are provided to help make your office visit more convenient.

These PDFs may be downloaded, viewed and printed on your computer.
To download these forms, right-click on the appropriate icon and choose "Save Target As...".

General Patient Information

History PE

This form will allow you to complete your medical history prior to your appointment. Please print this form and fill it out, then bring it with you when you visit the Vein Center.

Patient Instructions

These instructions will give you information regarding your procedure. It should answer most of your questions and let you know what to expect during the course of your treatment.

New Patient Packet

These New Patient Packet forms are also available in a single zip archive.

Acknowledgement of Review

Patient Information Form

PIF Assignment of Benefits

Privacy Agreement

History PE

Financial Policy

Fact Sheet

Notice of Privacy Practices

Restless Legs Syndrome Information

RLS History

This form is provided to gather a general history of your RLS symptoms.

RLS Questionnaire

This questionnaire covers how your Restless Legs Syndrome might affect your quality of life.

RLS Rating Scale

This form has been developed to help rate the severity of your condition.

Directions to Our Clinic

The Vein Center of North Texas is conveniently located at
102 Memorial Drive, Suite 101, Denison, Texas,
just east of the main campus of Texoma Medical Center.

Get detailed directions from your location to our clinic.

If you have trouble, call us at (903) 465-7070.