Patient Information
Info for new patients, payment info, insurance info, downloadable pdf patient forms, etc.
If you are a new patient, please download, print and complete all the forms below and bring them to your appointment
Payment Options
For your convenience, we accept cash, personal checks, debit cards, and most major credit cards. Payment is expected at the time services are performed.
If you are a new patient, please bring a valid form of ID and your insurance card. If you are an established patient and your insurance policy has changed, please bring your new insurance card to your next scheduled appointment.
Espinoza Vein Institute is required to invite all new patients to participate in a government Social Needs Survey. If you choose not to participate, please select the appropriate box and sign. All new patients must submit a form at the time of check in.
Frequently Asked Questions
What will happen at my first visit?
Your first visit will be an evaluation of your symptoms/complaints and provide a diagnosis. All information about your symptoms, family history, medication and other health conditions, will be taken by a Medical Assistant. A medical doctor will then review your chart, conduct a physical exam (if required) and discuss your symptoms, and explain the diagnosis.
If you are diagnosed with vein disease, it may be recommended for you to have a diagnostic ultrasound to determine the location(s) of the disease, among other factors.
The diagnostic ultrasound is done at our facility and you will be scheduled (if you choose to) at the end of your first visit. An ultrasound is a non-invasive test performed by a qualified sonographer. Ultrasound uses sound waves to generate images of your veins and blood flow. These images help us find potential sources for your symptoms.
What should I bring to my first visit?
- Be prepared to explain your symptoms as clearly as possible.
- Bring a list of your current medications.
- Advise us if you’ve ever had a blood clot, leg injury, leg procedure, if you’re pregnant and/or if you have a family history of vein problems.
Am I at risk for vein disease?
Men and women can be at risk for vein disease. However, certain factors increase your risk level:
- Family history of vein disease or disorders
- Prolonged sitting or standing
- Recent leg injury or surgery
- Previous blood clot in the leg
- Overweight or obesity
- Lack of physical activity
- Pregnancy
- Hormonal replacement therapy or hormonal birth control
- Older age
If you have one or more of these risk factors or experience any symptoms of vein disease, be sure to see your primary care provider or an experienced vein care specialist.