Should it be determined that surgery is recommended to correct any venous insufficiency, it would be best if you come to your ultrasound appointment prepared with your preferred dates to schedule your surgery. Openings are usually available one to two months out. Please mark your choices at the bottom of this form, and bring this form with you to the ultrasound exam, so that we can quickly reserve a date for you on the surgery schedule.

Scheduling Your Surgery:

The medical care of your venous condition requires several appointments and procedures, and much staff time is involved in scheduling those appointments and procedures…not only with our office, but also with the ultrasound technician, with the hospital, and with your Insurance company. We will send the request and paperwork to your insurance company. If you have PPO Insurance, you must follow up with your Insurance Company to confirm your benefits.

For these reasons, we ask you to carefully consider what dates would be best for you should you need surgery, and a $250 deposit is required at the time of scheduling to hold your place on the schedule. If you need to reschedule or cancel your surgery date, please notify the office no later than 2 weeks prior to the surgery date. The deposit is non-refundable should you cancel or reschedule unnecessarily less than 2 weeks from your surgery date. Therefore, please schedule your surgery date only after very careful consideration of your own calendar. Also consider in your scheduling the fact that you may NOT fly for the following month, and you should not plan activities that will expose the incisions to excessive sun. Remember that the other appointments for your ultrasounds and mapping and follow-up care are specific dates tied to your chosen surgery date, as follows:

If you choose a Tuesday afternoon surgery date, your schedule will be:
Pre-op Ultrasound/Vein Mapping ……Either the day before or the morning of surgery
Surgery…………………………………………Tuesday afternoon
Post-op Ultrasound and Exam…………..Thursday afternoon or Friday morning

If you choose a Friday afternoon surgery date:
Pre-op Ultrasound/Vein Mapping……… Either the day before or the morning of surgery
Surgery…………………………………………..Friday afternoon
Post-op Ultrasound and Exam……………Monday afternoon

The pattern of the appointments for surgeries may change due to holidays and vacations. All appointments, except the surgery, are at the Vascular Specialists office.

For PPO insurance patients (self-pay), payment for surgery should be paid anytime before the surgery. If we have not received the payment, it will be collected the day of your pre-op ultrasound / vein mapping.

Your Preferred Surgery dates: _________, or __________, or __________, or __________