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.