Patient Forms for Northern Illinois
To provide you with the best treatment, we must gather important information about your medical history and current physical condition. We also need to keep emergency contacts and insurance information up-to-date.
To save time at your appointment, you can fill out the forms prior to your appointment time. Click on the links below to download and print the PDF forms. Then, hand the completed forms to the receptionist when you check-in for your scheduled appointment.
- NIVC Revised New Patient Information
- NIVC Revised Exam Questionnaire
- NIVC Varicose Vein Overview
- NIVC EVLA Consent Form
- NIVC Pre- & Post-Laser Instructions
- NIVC Pre- & Post- Sclerotherapy Instructions
- NIVC What Is Sclerotherapy?
- NIVC Sclerotherapy Consent Form
- NIVC Treatment Timeline
The above forms require Adobe Acrobat Reader™. You may download Acrobat Reader by clicking here:
If you choose not to fill the forms out before your appointment, please arrive 15 minutes early to complete them in our office.