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Patient Forms

We offer easy access to the most common patient forms used during your care at the Vein Healthcare Center. Our downloadable forms list provides a simple way to access patient information or access forms required prior to your appointment at the Vein Healthcare Center. Our staff at the Center will direct you to the forms appropriate for your visit.

Being fully prepared for your appointment and following guidelines for care before and after treatment will facilitate the best experience and promote the most effective healing so you can return to your daily routine as soon as possible.

Patient Demographics Form
General patient information

Patient Health + Medical Information Form
Medical information and health history

Exceptional patients care is our first priority. If you have any questions about treatment or about your upcoming appointment, please call the Vein Healthcare Center at 207-221-7799. We are available to answer questions and address any concerns you may have.

Pre-operative and Post-operative Patient Information

Pre-op info for EVLA | (PDF Version)
Post-op info for EVLA procedure | (PDF Version)
Pre-op info for RFA | (PDF Version)
Post-op info for RFA | (PDF Version)
Pre-op info for Sclerotherapy | (PDF Version)
Post-op info for Sclerotherapy | (PDF Version)
Pre-op info for Varithena | (PDF Version)
Post-op info for Varithena | (PDF Version)
Pre-op info for VenaSeal | (PDF Version)
Post-op info for VenaSeal | (PDF Version)
Pre-op info for Ambulatory Phlebectomy | (PDF Version)
Post-op info for Ambulatory Phlebectomy | (PDF Version)

Patient Consent Forms (PDF)

Informed Consent Form for EVLA procedure
Informed Consent Form for RFA procedure
Informed Consent Form for Sclerotherapy procedure
Informed Consent Form Varithena procedure
Informed Consent Form for VenaSeal procedure