Heart Patient Forms

Below are some of our most used documents and forms. Please take a moment to print and complete the appropriate forms as needed.

• Notice of Privacy Practices - This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

• Family Communication Form - This form designates who can receive communication about your condition and treatment.

• Patient Authorization Record - Form Authorizes Cardiology to release patients records to a facility or doctor. This form must be completed in its entirety before any information will be released. See form instructions.

• FMLA - Disability Forms - Cardiology will complete forms for FMLA or disability only if the leave is a result of the patient’s cardiac condition.The patient must answer all of the following questions, sign a release and pay $25 when leaving the required paperwork at Cardiology.

• New Patient History Form - Please speed up your initial appointment time in the office by completing and printing the New Patient Forms.

• Existing Patient History Form - Your medical history is an important tool to help us provide the best care.

• Provider to Provider Letter - Sometimes we will need medical information from other doctors or facilities who have treated you. This form is used to request medical information.