Patient Forms
Office Policies
Please note, children under 12 are not permitted to wait alone in our waiting rooms and/or allowed with patients into the exam rooms as we are not a child safety proof facility. Patients may be asked to reschedule if they bring a child to their appointment.
No Cash Payments
As of Monday, February 1, 2010: Circulatory Centers will no longer accept cash payments from patients. Patients can pay with checks, money orders or by credit cards. Any questions regarding payments please feel free to contact your patient account representative at 1-800-986-9759 or email us at info@circcenters.com.
Please download, review, print, complete, and bring the appropriate form(s) to your first appointment.
New Patients (No-Charge Consultation)
Please print out and complete the all of the following forms and bring with you to your first no-charge consultation appointment.
For directions to one of our offices, click here.
New Patients (Next Appointment After No-Charge Consultation)
Please print out and complete the following forms and bring with you on your second appointment.
Procedure Information
Please print out this information for your convenience.
- Why is an Ultrasound Given? (pdf)
- EVLA Pre-Op Instructions (pdf)
- EVLA Home Going Instructions (pdf)
- Phlebitis Home Going Instructions (pdf)
Patient Account Representative Contacts
Our Patient Account Representatives (PAR) are here to answer any questions regarding your account. Please contact your PAR based on the location where you are having treatment.
Kim Albright
PAR WVA Morgantown Office, claims follow up and multiple misc. billing tasks.
kalbright@circcenters.com
Patty Edwards
PAR for all Ohio Offices.
pedwards@circcenters.com
Melissa Hathhorn
PAR for St. College, Somerset, Altoona & other misc. billing tasks.
mhathhorn@circcenters.com
Joyce Sekerak
PAR Pittsburgh Offices Erie, Fox, Monroeville, Moon, S. Hills, Wexford, Downtown Pittsburgh Par.
jsekerak@circcenters.com
For more information regarding Circulatory Centers or to schedule your FREE Diagnostic Consultation – please contact us at 1-800-526-3082 or email us at info@circcenters.com.