Patient Checklist

To better serve our patients, the following information is necessary on or before your initial office visit.

 

YOUR PERSONAL INFORMATION

  • Email (if applicable)
  • Photo identification
  • Insurance information | Please bring your insurance card with you.

Beginning January 2014 we are now required by your insurance company to collect your co-pay at the time of service.

A copy of the order form from your referring physician is required before your study may be performed.

 

Referring Physician Information

  • Physician Name | Address | Phone Number

YOUR Medical History & Records

  • Medication List. Also, include all vitamins, herbals, or over-the-counter pills or remedies.
  • The discharge summary from any recent hospital stays (within the past 3 to 5 years).
  • Listing of any implanted devices such as pacemakers, implants, or stents.
  • Any diagnostic tests or procedures, such as chest x-rays, CT scans, MRIs, or ultrasounds, please obtain the images or films.

Additional Visit Preparation Information

  • You are encouraged to bring a family member or friend on the day of your appointment, although 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 may be performed.