How to Refer

Provider Referral's

If you are physician or physician’s office and you are referring a patient from your office to us, please provide us with the following information:

  • Physician’s name and office phone number
  • Office address
  • Patient’s name
  • Patient’s demographics including address, phone number, etc.
  • Reason for referral
** Please provide insurance information that the patient has so that we can verify the patient before their visit.**

Any tests or labs that have been completed for Dr. Siddiqui to have on file before he sees the patients.

Please fax over the information to (817) 225-2719.

Please call our friendly office staff at (817) 225-2716 if you have any questions or need further information to refer a patient.
** THANK YOU FOR YOUR KIND REFERRALS!!**
 
 

Contact Information

TOTAL VASCULAR, VEIN,
AND WOUND CLINIC
309 Regency Pkwy, Suite 207
Mansfield, TX 76063-4619

Phone: 817-225-2716
Fax: 817-225-2719

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Total Vascular, Vein and Wound

Our goal is Keeping You in Circulation.
We provide compassionate, competent care in all aspects of varicose veins in the Mansfield area.

Contact Us

  Email us at: placebo (@) yoursite.com

  PHONE: 817-225-2716

   FAX: 817-225-2719

309 Regency Pkwy, Suite 207
Mansfield, TX 76063-4619