Forms

Please fill out all of these forms completely and bring with you to your appointment:

• Patient Registration Forms
• Patient Consent Form
• Medical History Worksheet  
• Prescription-HIPAA Consent  
• Medical Records Release
• Peripheral Vascular Disease questionare (Optional but recommended)

Sclerotherapy Patient Instructions

At Vascular Specialists of Central Florida, we recommend you come into the office for a scheduled consultation prior to your sclerotherapy session.  During this consultation it will be determined if you are a candidate for sclerotherapy, and if so, all of your questions regarding the procedure will be answered at this time.    This way, when you come for your session, time will not be taken away from your appointment discussing the procedure.  The average cosultation lasts approximately 15 minutes.  Sclerotherapy sessions can be scheduled for 1/2 hour or 1 hour, as desired.

Pre- and post- procedure instructions are available by clicking the following links:

Pre-sclerotherapy instructions

Post-sclerotherapy instructions

Please be advised we try to stay on time for our sclerotheapy appointments.  Arriving late will limit the time of your treatment.  Your treatment will end on time so the next client will not be delayed.  The full value of your treatment will be charged.  If you reschedule or cancel your appointment, please notify the practice at least 24 hours in advnace to avoid being charged the full service fee.  Please be advised we do not perform sclerotherapy on pregnant or breastfeeding women.  

If you have any questions about sclerotherapy please feel free to call Katie, our sclerotherapy scheduler, or Aubrey Harman, ARNP, our sclerotherapist at 407-648-4323.