UFE Patient Intake Form

This form can be downloaded, printed. Fill out the form and then save it. Email the form to jorlando@teamviv.com or sbagla@teamviv.com

Discharge Instructions

This form can be downloaded by clicking on the icon. This covers what to expect after the procedure. For radial access (wrist), the instructions are different in terms of limitations of activity and groin care. It is sometimes customized by the physician for individual patient situations

Pre-procedure Instructions

This form can be downloaded by clicking on the icon. This covers what to expect before the procedure. It is sometimes customized by the physician for individual patient situations

© 2016 - 2018 by The Vascular Institute of Virginia

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To Schedule An Appointment

Call 703.763.5224