Patient Information
Information For New Patients to our Houston Vein Center
Insurance and Payment Information
We accept all major insurance carriers and Medicare.
Insurance plans often cover ultrasound testing and Vein Treatment when it is for medical reasons. Only a comprehensive examination can document the existence of medical necessity.
New Patients
In order to serve you better and faster we have provided our New Patient Information Form and Medical History Form online.
Download the New Patient Information Form, Authorization Form, and Patient Privacy Notice
Instructions:
Click on the links below to access the forms. After you click the link, a new browser window will open. After it opens, click on the 'PRINT' icon on your browser. After the form prints, fill it out and bring them into our office. Completing the New Patient Information Form and Medical Record Form will save you time on your initial visit!
New
Patient Information Form*
Medical History*
Authorization
Form*
You must have an Acrobat Reader to view the Acrobat files. If you don't already have Adobe Acrobat, you can download the Acrobat Reader Free.
Name:
Email:
Phone:
Interest:
Cosmetic Vein Centers of Texas
445 Bay Area Blvd.
Houston, TX 77058
Phone: 281-990-VEIN (8346)
Fax: 281-990-9984