Microsoft Word - VC new patient paperwork.docx
Have you ever been treated for vein problems? If yes, by whom, when and where: Do you have a family history of vein symptoms (varicose veins, spider veins, leg ulcers, blood clots or swollen legs?) a. If yes, who? Do you have a personal history of the following? (Check all that apply) Blood Clots/Phlebitis Thyroid High Blood Pressure ................
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