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  • Conditions
    • Claudification
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    • Venous Compression
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    • Atherosclerosis
    • Arterial Occlusion
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    • Angiogram
    • Balloon Angioplasty
    • Venous Stent Placement
    • Laser Atherectomy
    • Intravascular Ultrasound
    • Venogram
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    • Home
    • Lofton N. Misick, M.D.
    • Patient Forms
    • Request An Appointment
    • Conditions
      • Claudification
      • Critical Limb Ischemia
      • Venous Compression
      • Venous Insufficiency
      • Atherosclerosis
      • Arterial Occlusion
    • Procedures
      • Angiogram
      • Balloon Angioplasty
      • Venous Stent Placement
      • Laser Atherectomy
      • Intravascular Ultrasound
      • Venogram
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  • Home
  • Lofton N. Misick, M.D.
  • Patient Forms
  • Request An Appointment
  • Conditions
    • Claudification
    • Critical Limb Ischemia
    • Venous Compression
    • Venous Insufficiency
    • Atherosclerosis
    • Arterial Occlusion
  • Procedures
    • Angiogram
    • Balloon Angioplasty
    • Venous Stent Placement
    • Laser Atherectomy
    • Intravascular Ultrasound
    • Venogram

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Bay Vascular Surgery

Bay Vascular SurgeryBay Vascular SurgeryBay Vascular Surgery

The Bridge Between Life & Limb

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Patient Forms

Current Visit/Insurance Form

Medical Release of Information

Current Visit/Insurance Form

Please provide us your insurance information for upcoming visit.

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Medical History

Medical Release of Information

Current Visit/Insurance Form

Your medical history allows to make safer, smarter decisions.

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Medical Release of Information

Medical Release of Information

Consent for Purpose of Treatment

This allows your medical information to be released to necessary parties.

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Consent for Purpose of Treatment

Consent for Purpose of Treatment

Consent for Purpose of Treatment

 This allows our staff to provide you with treatment and care. 

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PAD Questionnaire

Consent for Purpose of Treatment

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Consent for Purpose of Treatment

Can't Find the Right Form?

Give us a call at (361) 761-8610 and our staff will be more than happy to assist you. 

Consent for Purpose of Treatment

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Current Visit/Insurance Patient Form

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Medical History

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Medical Release of Information

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Notice of Privacy Practice

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PAD Questionnaire

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NO SURPRISE BILLING ACT

 Notice: As required by the No Surprises Act, patients are entitled to receive a Good Faith Estimate for medical services. For more information contact our office at  (361) 761-8610 . 

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