a reflux free life

Contact Us

(863) 402-5600

In order to get started, there are just a few forms we need you to fill out.


Please print the form you need, fill it out, and fax it to (863) 402-5602.


If you have any questions regarding the forms, please contact our office at (863) 402-5600.


Thank you!

Florida Lakes Surgical Registration

Endovenous Ablation Consent

Sclerotherapy Consent

Sclerotherapy Pre-Treatment

Sclerotherapy Post-Treatment


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