Lawrence Vein Center Patient Forms - Lawrence Memorial Hospital

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Patient Forms

To make your initial visit to our vein clinic more convenient, please download, print and complete the forms below and bring them with you.

Patient Registration Form (docx) »

Consent Form (docx) »

Consent Form Spanish version

Patient History Form (pdf) »

Vein Screening Form (pdf) »

Call Lawrence Vein Center at 785-856-VEIN (8346) for assistance or appointments.

Learn more about treatment options at one of our FREE screening events*.

To register, 

call 785-856-VEIN (8346)

*The free screening is not available to Medicare and other federal healthcare beneficiaries.