For Patients
Patient Checklist - Information We Require
We require the following information before or during your initial office visit:
Information about you:
- Name
- Date of birth
- Address
- Phone Number
- Email (if applicable)
- 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)
- Email (if applicable)
Your Medical History and Records
- Bring a list of your medications. Also include all vitamins, herbals, or over-the-counter pills or remedies.
- Bring the discharge summaries from any recent hospital stays (within the past 3 to 5 years).
- Bring 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 absolutely necessary, unless your procedure requires a driver to take you home.
- A copy of the order form request from your referring physician is required before your study can be performed.
