Forms & Appointments

Learn more about what steps you need to take regarding your first visit to our varicose and spider vein clinic.

What to Expect on Your First Visit

During your initial consultation at Boulder Vein Center, you will first see one of our in-office Registered Vascular Technologist who will map out and measure your veins. Following your ultrasound, you will meet with Dr. Richard Fox or Dr. Akin Beckley, our vascular surgeons, and use the information gathered during the ultrasound, your vein doctor will determine if you are an eligible candidate for EVLT, Microphlebectomy, or Sclerotherapy. In some cases, your surgeon will also recommend that you wear compression socks, which are available for purchase in our office. Our Medical Assistants will be happy to measure and fit you for a pair.

If you are an eligible candidate for a varicose vein or spider vein treatment, you will meet with the surgery scheduler and schedule a date and a time for your procedure that is convenient for you. This date will usually be about one month from your initial consultation to allow us enough time to contact your insurance company and obtain any necessary prior authorization. In addition, we will provide you with an insurance-specific estimate and a maximum figure for your out-of-pocket expenses for your procedure. The scheduler will review with you the pre/post-procedural instructions and answer any additional questions you may have.

What to bring

To better serve you, please bring the following to your consultation:

  • Insurance Card(s) and Photo ID
  • Completed Patient Information Forms (See Below)
  • Physician Referral and Office Notes (if applicable)
  • Method of Payment for Co-Pays, Deductible and Co-Insurance
  • A pair of loose-fitting, comfortable shorts

New Patient Forms

Prior to your initial consultation, please print and complete all 7 pages of the Patient Information Forms. Please remember to include all details regarding medications and other surgeries on your paperwork.

Please print these forms single-sided:

Download New Patient Form

Spider Vein New Patient Information Forms

Vein/Leg Pain History Form

HIPAA – Notice of Privacy Practice

Please review the HIPAA policy below prior to your consultation. Be sure to sign the HIPAA acknowledgment form confirming you have read this document.

Download Privacy Statement

Download HIPAA Acknowledgement Form

Procedure Information Forms

EVLT/Microphlebectomy Paperwork

Pre-Procedure Instructions

Post-Procedure Instructions

EVLT Consent for Procedure

Sclerotherapy Consent for Procedure

As always, please give us a call at

303-449-8346 if you have any questions about your visit. We look forward to seeing you soon.

Requests for Health Information

 How do I request a copy of my health information?

Please complete our Authorization of Medical Release form (PDF) below and either mail, fax (303.440.7298) or drop it off at Boulder Vein Center.  All requests will be processed within 5 business days after receiving a completed form and any additional information required.

Who is authorized to sign the release for my health information?

  • Patient (Not your Spouse or Partner)
  • Power of Attorney (Legal Documentation must be provided with a request)
  • Parent (if the patient is younger than 18).
  • Legal Guardian (Legal Documentation must be provided with the request)
  • A representative of the estate for deceased patients (Copy of the death certificate and documentation detailing Representative must be provided with the request).

How much does it cost to obtain a copy of my health information?

There is no charge for releasing copies of health information directly to other healthcare providers or other entities identified under HIPAA.

Patients that are requesting a copy of their information will be charged for copies of their records.  The fees are as follows:

Pages 1-10$10.00
Pages 11-25$25.00
Pages 26+$35.00

 

If you have any questions please contact our office at 303-449-8346.

If you would like to get a copy of your medical records sent to us or another office, please fill out the release form below and mail, fax or drop off at our office.

Authorization of Medical Record Release

Authorization to discuss medical and billing information with family / friends

Additional Forms

Instructions to log onto Patient Portal

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