• Christopher J. Bosarge, M.D.
• Harry R Cramer Jr., M.D. F.S.I.R.
• Stuart Harlin, M.D. F.A.C.S.
• Fernando Kafie, M.D. F.A.C.S.
• Christopher J. LeCroy, M.D.
• Aaron B. Montgomery, M.D.
• John Tucker, M.D. F.A.C.S.

Coastal Vascular
Interventional Center
Coastal Vein Institute
1851 North 9th Avenue Suite B
Pensacola, Florida 32503
For Appointments Call
850-912-8847

Sacred Heart Medical Mall
5147 North 9th Avenue
Suite 318
Pensacola, Florida 32504
For Appointments Call
850-479-1805

Baptist Hospital
Baptist Medical Tower #2
1717 N. E Street Suite 524
Pensacola, Florida 32501
For Appointments Call
850-437-3777

Patient Forms

• Patient Information
• Patient Medical History
• Consent Form
• HIPAA Consent Form
• Florida Patient Bill of Rights and Responsibilities
• Benefits & Financial Policy
• Screening Form

THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT.