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Please enter the information and press the “Submit” button when you are through.

First Name

Middle Name

Last Name

Disease/Condition

Do you have a current referral from your Primary Care Physician?

Yes No

Do you have current Vascular Studies CTA/MRA/Angiography (within last 3 months)?

Yes No

Home Phone Number

Mobile Phone Number

Business Phone Number

Preferred Contact Method

Email Phone Call

Additional Information/Comments

(*) Your name and phone number or email are required fields, so that we can contact you to confirm your appointment

Documentation for Appointments

When you come for your Appointments, please remember to bring the following

Driver's license or State ID
Insurance information
Copies of operation records, medical records, x-rays, MRIs, CT scans and so on from prior doctor visits
Medications list (if any)
If you have had surgery elsewhere, please bring a copy of your operation report

Cancelling an Appointment

Telephone the office during business hours. Please cancel at least 1 day ahead so that your appointment time can be allocated to another patient who is seeking treatment.

Make your Appointment

Miami Vascular Surgery

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