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Patient Forms

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Fill out these online forms before your visit

At La Jolla Vein & Vascular, we want to know about your health to determine the best course of action for your individual needs. These forms help us better understand your current conditions and symptoms. We appreicate your time is valuable and thank you in advance for your cooperation.
The following forms can be accessed, filled out and submitted online for your convenience.
New Patients
If you are a new patient, please fill out the forms below prior to your appointment. Your form submission is secure and private.

NEW PATIENT REGISTRATION FORM – VARICOSE VEINS
FORMULARIO DE REGISTRO DE NUEVO PACIENTE – ESPAÑOL
These forms are available to fill out as required by patient or La Jolla Vein & Vascular
MEDICAL RECORDS RELEASE FORM
AUTHORIZATION FOR RELEASE OF INFORMATION
PATIENT RESPONSIBILITY – INSURANCE DISCLAIMER

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Dr. Amanda Steinberger is a Harvard-trained, board-certified vascular interventional radiologist. She specializes in a broad range of superficial vein disease including varicose veins, spider veins, venous leg ulcers, lymphedema and cosmetic laser vein treatments. Dr. Steinberger sees patients in our La Jolla Office.

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Depending on your insurance plan, you may or may not have out of pocket expenses. We work with your insurance providers to maximize your insurance coverage and provide a complete overview of your treatment cost. We believe in cost transparency and will provide a cost estimate of any anticipated out of pocket expenses. Cost is important. We can work with your insurance to find out this information today!
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Can I get insurance coverage for my vein treatment?
With Molina insurance plans, most patients should not have out of pocket expenses. We work with Molina to maximize your insurance coverage and provide a complete overview of your treatment cost. We believe in cost transparency and will provide a cost estimate of any anticipated out of pocket expenses. Cost is important. We can work with your insurance to find out this information today!