For Patients

Patient Forms

Prior to your appointment with us, you will need to complete several forms providing contact, health, and insurance information. We have provided copies here as a convenience. Simply print and complete these forms and bring them with you to your appointment. If you choose to complete these forms while in our office, we simply ask that you please arrive at least 15 minutes prior to your scheduled appointment.

• **Important: Please bring all medications to your next appointment.**

New patients will need to complete the following forms:

• Patient Registration Information
• Health Questionnaire
• Assignment of Benefits
• Written Acknowledgement Form
• Vascular Disease Risk Assessment

Returning patients need only to update their health information:

• Nurse Worksheet
• Vascular Disease Risk Assessment

CT Heart Scan patients will need to complete the following forms:

• Patient Registration
• CT Heart Scan Consent
• Written Acknowledgement Form

Vascular View patients will need to complete the following forms:

• Patient Registration
• Written Acknowledgement Form

Other forms you might find helpful are included here, as well:

• Test Instructions
• Maps & Directions
• Summary Notice of Privacy Practices
• Full Notice of Privacy Practices
• Permission to Release Medical Information
• CTA Disclosure for Medicare Patients