Forms
Referral Vein Worksheet - for Providers
Referring Providers may use this convenient referral worksheet with checkboxes for signs and symptoms, assessment (ICD 10 codes), recommendation/plan, and any notes.
Quickly fill out the form online and receive an email copy for your records:
Online Referral Vein Worksheet Form
Alternately, download the PDF form, fill out, and email or fax to Alsara Vein Clinic:
Download Referral Vein Worksheet
Missed Appointment/Cancellation Policy
When you schedule an appointment with us, we block off time specifically for you. If for any reason, you are unable to keep your scheduled appointment time, we ask that you please inform us as soon as possible. We are then able to offer that time to another patient. Please know that if you need to cancel within 24 hours of your appointment, you will be charged a fee of $50. For mapping appointments and procedures, the fee is $100.
Patient Privacy (HIPAA)
St Joseph Travel Info
Our clinic is within 30 minutes of Kansas City International Airport. By request, we can arrange to shuttle you to/from the airport and assist with your hotel accommodations.
There are a variety of area hotels for any budget. For a list of area hotels, as well as cabs, car rentals, and bus travel options:
Download St Joseph Travel Info
Please call us for details at +1 816-396-0245 (or toll-free: 844-425-7272) for assistance with travel accommodations.