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Registration Form
FORMULARIO DE INSCRIPCIÓN
Questionnaire
CUESTIONARIO INICIAL
All patients should complete the following forms and submit them to our office prior to the initial consultation. Please download each file, print, and fully complete them. You can e-mail, fax, or postal mail them. You can choose to also bring them to your initial consultation.
If you have any questions, please call our main office at 1.847.550.0020.
DOWNLOAD FORM
Format: .DOC (Microsoft Word)
VERSION EN ESPAÑOL
DOWNLOAD FORM
Format: .DOC (Microsoft Word)
VERSION EN ESPAÑOL
© Copyright 2014-2020 Vein Care Specialists, Ltd. All rights reserved. Not all patient candidates will qualify for treatment. Main Office: 712 N. Dearborn Street, Chicago, IL 60654
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