PATIENT FORMS

Full Patient Visit Packets

Individual Patient Visit Forms

• New Patient Packet​

• Established Patient Packet

• Patient Demographics Form​

• Patient Privacy Notice (HIPAA)​

• New Patient Questionnaire​

• Established Patient Questionnaire​

• Authorization For Release of Medical Records TO HeartPlace​

• Authorization For Release of Medical Records FROM HeartPlace​

• Blood Pressure Log

Patient Testing Instructions

• Abdominal/Renal Ultrasound​

• Arterial Study​

• Carotid Ultrasound​

• Echocardiogram​

• Nuclear Stress Test - AM Appointment​

• Nuclear Stress Test - PM Appointment​​​

• Stress Echocardiogram​

• Stress Test​

• Venous Study​

Patient Procedure Instructions

POST PROCEDURE​

• Pacemaker​

• ICD​

• Angioplasty/Stent​

• Open-Heart Surgery

Patient Education

• 10 Ways to Reduce Cholesterol

• The Dizzying Diet

• Exercise Benefits

• Harmful Supplements

• Hypertension FAQs

• Limiting Salt Intake

• Food Label Facts​

• Red Yeast Rice

• The Gorge Yourself Environment

• Obesity FAQs

• Non-Prescription Supplements

• Irregular Heart Beats

• My Diet Strategy - Controlled Indulgence