Patient Resources and Forms

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.

• Texas Endovascular Medical Release
• Houston Fibroid Intake Form
• HIPAA Notice of Privacy Practices

Local Hotel Partnership

We offer our out of town patients a negotiated rate on local hotel rooms at the following locations:

TownePlace Suites Houston Galleria

• Property Fact Sheet
• Negotiated Rates and Additional Details

Candlewood Suites

• Negotiated Rates and Additional Details

Online Resources

Follow us on Facebook and Twitter for news and information about vascular disease, uterine fibroids, UFE, and other health topics.

• Ask 4 UFE
• Office on Women’s Health

For Referring Physicians

At Texas Endovascular, we appreciate the relationships we create with the physicians we work with and who refer their patients to our clinics.
Please follow the steps below to refer a patient to our offices. If you have questions, feel free to contact us at 713-575-3686.

Steps to Refer a Patient:

• Step 1: Download and complete the referral form (PDF).
  • You can also complete the form online
• Step 2: Fax the Referral Form along with a copy of the patient’s information and insurance information to us:
  • Fax Number: 713-575-3688
• Step 3: Our team will verify the patient’s benefits and call to schedule an appointment (we recommend following up with your patient to ensure that an appointment has been scheduled).

Patient Referral Form