New Patient Paperwork
As a new patient, we welcome you to the Cardiology Wellness Center and commend you on your choice to get on the road to good health. Before becoming a patient, however, there are certain forms and documents we would like for you to download and print at home. In order to best serve you when we meet, we ask you to complete these forms prior to you visit and to answer the questions to the best of your knowledge. If you are able to complete the forms prior to your visit, despite their inconvenience, we will be in a better position to serve your needs and to minimize the administrative delays in getting you registered.
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First start with the first-time patient’s check list: Check List, which provides a list of items to fill out prior to your first visit.
- Introductory Letter to New Patients – provides information about the practice and priactice locations.
- Health New Patient Questionnaire – provides us with information about your current health status and problems.
- Office Registration Form – provides us with your contact, emergency contact, and billing and insurance information.
- Transfer of Medical Records – allows the practice to obtain your medical records.
- Patient Confidential Preferences – gives us permission to contact individuals of your choice and discuss your medical conditon
Returning Patient Paperwork
As a returning patient, we thank you for choosing the Cardiology Wellness Center as your method of choice for getting on the road to good health. We would like to ask, however, that you review and fill out the following forms before your next visits.
You will need Adobe Acrobat Reader to view these forms. To download a free copy of Adobe Acrobat Reader, Click Here.
First start with follow-up patient’s check list: Check List, which provides you a check list of things to do prior to your next visit.
- Follow-Up Health Questionnaire – provides information about your past and current health status and problems.
- UpDate Information Form – provides us with your contact, emergency contact, and billing and insurance information.
- Transfer of Medical Records – allows the practice to obtain your medical records.
- Patient Confidential Preferences -gives us permission to contact individuals of your choice.
Practice Privacy Policy
At Cardiology Wellness Center, we take seriously our obligations to maintain the strictest measures to protect your personal information. Enclosed is our privacy policy. After reviewing this policy, please acknowledge by signing the attached form your understanding of your rights as a patient.
You will need Adobe Acrobat Reader to view these forms. To download a free copy of Adobe Acrobat Reader, Click Here.