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Patient Forms and Resources


Making the Most of Your Visit

We provide free compression stockings to all the patients that decide to undergo vein procedures. Have all your current medical insurance information and your identification available when you arrive.

If you are a new patient you should arrive 15 minutes before your appointment to complete the new patient forms and verify your insurance information. You can download and print the form and bring it filled with you to save time.

New Patient Form

Bring all the actual medications bottles with you or at least a current list of all your medications. Please allow sufficient time for your appointment. If you are an existing patient, we ask you to allow at least one hour for your visit. If you are a new patient allow at least one and a half hour time. Depending on how complex is/are your problem/s, the doctor might need more time to perform testing during the visit as well as to review records and discuss plans with you.

It’s very helpful to prepare a list of questions and bring it with you. If you had a recent hospital admission to any hospital (except W. Beaumont Hospital), or testing (blood tests, ECG, echocardiograms, stress tests, etc) done at any other office or facility, it will be very important you notify us at the time you book the appointment. We will need you to fill out a release of records form so that we can request those records before your visit. You can download that from this website and fax it to our office to save time and expedite the process. 

Medical Information Release Form

During your appointment, be sure to review your treatment plan and medications with your doctor. If you need additional information, educational materials are available for you to take home.

We like to keep your other treating physicians updated of your condition, evaluation and plans. Make sure to bring with you the name, address, phone and fax number of any physician you would like us to forward your records.

Prescription Refills

Be sure to request medication refills at the time of your office visit. If you need refills between office visits, please call during normal business hours. Provide the name of your medication, the dose, frequency and your pharmacy’s telephone number. Allow up to 24 hours for the prescription be sent to your pharmacy. Our office makes most of the prescriptions electronically. If you bring the accurate pharmacy information, we can send the information to your pharmacy when you check out and the medications will be ready for pick up when you return home.

If you have not been examined in the office within the past year, we request you have an office visit prior to medication being prescribed/refilled.


If you must cancel an appointment, a 48-hour notice will allow us to schedule another patient in that time slot. There is a $25 cancellation fee for office visits if you do not notify us with at least 24 hours notice.


Heart and Vein Center physicians participate with most major insurance companies, including Medicare, BCBS, Medicaid, PPOM, Blue Care Network, Health Alliance Plan, Aetna and Cigna.

Due to the complex and ever changing health insurance environment, it is very important that we have current and accurate information. We can’t process your claim promptly and correctly without correct information. In the event we have incomplete, or incorrect information, you may be responsible for the services. Therefore, we ask that you present all current insurance cards at every visit to Heart and Vein Center.

ATTENTION: If your medical insurance coverage is provided by a HMO/Managed Care plan, you are required to obtain a written referral/ insurance authorization from your Primary Care Physician (PCP) prior to each and every visit. Without an authorization, we will not be able to provide service and the doctor will not be able to see you that day.

Our reimbursement specialists are available to answer billing questions. However, your own insurance carrier representatives can best answer questions regarding specific insurance coverage, for example deductible and co-pay amounts and if a certain service will be covered.


As a patient, you are responsible for all co-pays and deductibles as specified by your current insurance plan. These payments are expected at the time of service. If you have Master Medical coverage, the office visit must also be paid at the time of service, and as a courtesy, our reimbursement specialists will promptly bill the insurance carrier for timely reimbursement directly to you.

For your convenience you may pay by cash, personal check, Visa or MasterCard. However, if your medical bill poses a hardship, we would be happy to set up a payment program in advance.



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The quick, minimally-invasive procedure involves injecting a specially formulated solution directly into the unwanted veins, which ultimately causes them to collapse and fade away.

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Hypertension, or high blood pressure, means that the pressure of the blood on the blood vessels is higher than normal.


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Arrhythmias refer to any abnormal or irregular heartbeat. Some arrhythmias can cause fluttering or palpitations, chest pain, shortness of breath or lightheadedness.

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Coronary Artery Disease

Coronary artery disease is a narrowing of the coronary arteries, which supply blood, oxygen, and nutrients to your heart.


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Heart Failure

Heart failure means that the heart isn’t pumping blood as effectively as it should be.



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Varicose Veins

They’re abnormally enlarged and gnarled, often resembling ropes that twist up and down your leg. They typically develop in leg veins, because they must work against gravity to transport blood back to your heart. 

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Venous Ulcers

A venous ulcer, or stasis ulcer, is a skin ulcer that develops on your leg due to underlying problems in leg veins.


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Restless leg Syndrome

Restless leg syndrome is a medical condition that causes crawling sensations and the urge to move your legs.

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Heart and Vein Center
18915 Twelve Mile Rd
Lathrup Village, MI 48076
Phone: 219-506-3186

Office Hours

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