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)
  • 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 drive to take you home.
  • A copy of the order form request from your referring physician is required before your study can be performed.

 

28 White Bridge Road
Suite 111
Nashville, Tennessee
37205

Phone (615) 356-3999
Fax (615) 353-0462