We require the following information before or during your initial office visit:
Information about you
- Name
- Date of birth
- Address
- Phone Number
- Photo identification
- Insurance information – please bring your insurance card with you
- A copy of the order form from your referring physician is required before your study can be performed.
Information about your referring physician
- Name
- Address
- Phone Number
- Fax Number (if applicable)
Your medical history and records
Please bring:
- A list of your medications. Also include all vitamins, herbals, or over-the-counter pills or remedies.
- Discharge summaries from any recent hospital stays (within the past 3 to 5 years).
- A list of any implanted devices such as pacemakers, implants, or stents.
- If you have had any diagnostic tests or procedures, such as chest x-rays, CT scans, MRIs, or ultrasounds please obtain the images or films.
Other important information to prepare for your visit:
You are encouraged to bring a family member or friend on the day of your appointment, though it is not necessary unless your procedure requires a driver to take you home.
Downloads
Forms on this page can be used by patients who would like to have their forms filled out before they arrive for their appointment.