Call Us:  907-222-6240

 

Robert R Artwohl, MD, PC  •  3300 Providence Drive, Suite 309  •  Anchorage AK  99508  •  Phone:  907-222-6240  •  Fax:  907-222-6870

This is the vein questionnaire for the Alaska Vein Clinic.  It should be completed by all new AVC patients.  We have very few required elements, but we would appreciate you taking the time to fill out the form as completely as you can. Different fields will appear based on your answers.

If you would prefer to download and print out a paper form, fill it out, and bring it to the office with you, click here:

 

Area(s) of Concern

If you like, you can download the leg diagram form below and use it in one of the three ways.

1. Mark your areas of concern with the application you used to open it, save and download it into the form as .pdf or Word (.docx) file.

2. Print it out, mark it, then scan or photograph it and upload the image to the form.

3. Same as choice 2, except just bring it with you at the time of your appointment.

 

Click Image Below to Download Diagram
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