Patient Forms – The Heart Smart Group Site

New Patient Form

It is important for us to know the medical history and related personal information for all new patients. If you have made your initial appointment with us, you can save time by downloading and completing the fillable New Patient Form. You may print out the completed form and bring it with you or save the form on your computer and email it to us as an attachment

Release of Previous Medical Records

If you have previously been receiving cardiac or other medical care, it may be important to obtain your previous medical records so that we have a better understanding of your current medical condition, diagnoses and treatment. We are unable to obtain records from another physician or treatment facility unless the release of such information and records is expressly authorized by you.

You may complete this authorization by downloading the form, completing it and bringing it with you to your appointment. Alternatively, we can provide the form to you at the time of your appointment.

Your Privacy Rights

By law, you have important privacy rights as they pertain to your health information and the sharing of that information. The New Patient Form requires you to acknowledge that you have reviewed our Privacy Notice, which may be accessed by clicking the button below. You may also request a copy at any time when visiting our office.