Generally the recommendation to come to Michigan Vascular Access will come from the patient's nephrologist (kidney doctor) or dialysis unit. Sometimes patients will hear of us from other patients. In any case, a phone call to the office is enough to get the process started. In most cases, the initial appointment in the office is designed to share information: we get information from you so that we can understand your problem, and we give you information about what we think we can do. No procedure will be performed in the office, other than an ultrasound examination of the arms. Ordinarily one meeting is enough for a recommendation for surgery to be made. We ask that you come with all insurance information, a list of medications, and any other medical information you may have. Someone from the office may call to review your medical history with your over the phone. This designed to save time and make your actual visit to the office more efficient Before your appointment, Please visit the "Medical Approach" section, and the patient education section