New Patient Paperwork

Welcome To Our Practice!

Thank you for choosing NYU Division of Vascular and Endovascular Surgery for your healthcare needs. We strive to provide the highest quality medical care and service.

To make your first visit to our practice as easy as possible, please take care of the following before you come:

1. Fill out the patient information forms that are available on our website.

   Vascular Center New Patient Forms

   • Registration
   • Financial Policy
   • Credit Card Authorization

   Vein Center New Patient Forms

   • Registration
   • Medical History 1
   • Medical History 2
   • Financial Policy
   • Patient Privacy
   • Credit Card Authorization
   
   
2. Please complete the entire form. We require all of this information in order to provide important information to the physician who referred you to us and in order to bill your insurance company properly. You can fax the form to our office at (212) 263-7722. Please bring the originals to your appointment.
3. If your insurance requires you to have a referral, please call your primary care physician (PCP) to obtain one. If you require a referral and you do not have one when you arrive at our office, then the physician will not be able to see you on the day you have scheduled the appointment.
4. If our office does not participate with your insurance plan, then payment will need to be made at the time of service. We accept cash, check, Mastercard, Visa and American Express.
5. If your insurance plan has a co-payment, co-insurance or deductible we will collect that payment at the time of your visit.

We look forward to seeing you at your appointment. If you have any questions prior to you appointment, please call our office at (212) 263-7311.

Thank you.