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Patient Forms

NEW TUSCAN CARDIO PATIENTS:

We appreciate the opportunity to participate in your health care. Please complete the following forms and bring them with you to your appointment.

NEW PATIENT FORMS
PATIENT REGISTRATION
COMMUNICATION OF HEALTH INFORMATION
STANDARDIZED HEALTHCARE QUESTIONS
FINANCIAL POLICY
VARICOSE VEIN QUESTIONNAIRE

We will need to scan a copy of your insurance card and driver’s license at each visit to ensure proper filing.

If your insurance is through a managed care program (HMO, EPO, POS), be sure to bring the appropriate authorization (referral) to see us. Without a referral, your appointment may need to be rescheduled or paid in full at the time of your visit. It is the patient’s responsibility to have a current referral on file for any future appointments.

The following items are essential to us in performing an effective evaluation:

  • Past records from your referring doctor or previous Cardiologist.
  • Please bring all your medications to each appointment.
  • If you are being referred for evaluation of chest pain or arrhythmia, we will need prior EKGs to compare to the EKG in our office.
  • If you are being referred for hypertension (high blood pressure), we need a list of all your medications tried by your referring doctor and blood pressure readings.

ADDITIONAL TUSCAN CARDIO FORMS:

Authorization to Release Medical Records
Notice of Privacy Practices
Your Nuclear Medicine Stress Test
Instructions – Stress Echo
No Show Appointments and Late Cancellations
Directions to Tuscan Cardiovascular Center