azura surgery center - long beach

Specializing in Dialysis Access Management & Vascular Care

+1 (562) 888-8961

info@southerncaliforniavascular.com
16506 Lakewood Blvd Suite 200,
Bellflower, CA 90706

Monday - Saturday 7:00 - 4:00

OPEN Saturdays - Sunday - CLOSED

+1 (562) 888-8961

info@southerncaliforniavascular.com

16506 Lakewood Blvd Suite 200

Bellflower, CA 90706

REFER A PATIENT - Click here to refer a patient to Our Surgery - Long Beach
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Patient scheduling form: Port/PICC

Patient Scheduling Form - Port/PICC

MM slash DD slash YYYY
MM slash DD slash YYYY
PORT
PORT Type
PICC
PICC Type

NOTE: In compliance with the Universal Protocol for Wrong Site Surgery, the LOCATION (below) must be completed in full by the referrer.

Location:

Labs needed - please fax:

• CBC • INR • BUN/Creatinine

Information needed - please fax:

• Insurance Card (Front & Back) • Most recent H&P
This field is for validation purposes and should be left unchanged.

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