Form
Facing heart or lung surgery is stressful. To make your first visit as smooth as possible and give you plenty of time with your surgeon, please complete your paperwork at home before you arrive. This helps your appointment time be focused on your care, rather than processing forms.
Click the button below to download the form. Please print these pages and fill them out completely using dark blue or black ink.
Viewing this on a smartphone? Enter your email address below to send this packet to yourself so you can easily print it from a computer later.
If you have already had surgery, but have not yet been into the office, you will need to complete these forms.
Viewing this on a smartphone? Enter your email address below to send this packet to yourself so you can easily print it from a computer later.
Your surgical team requires a strictly accurate, up-to-date list of your medications to ensure your safety. Please pay special attention to the Medication List in the New Patient Forms. You must include the exact name and dosage of every prescription, over-the-counter medication, and supplement you take.
Please bring the following items to your appointment:
Please be aware that you may not receive a surgery date at your first visit.
Your initial appointment is used to review your case and determine if you need additional pre-operative testing (such as a heart catheterization or lab work). Once all tests are complete and you are officially cleared for surgery, our scheduling team will call you to schedule your surgery. Surgeries are scheduled in chronological order.
GPS systems occasionally misdirect patients trying to find our main office.
We are located at 3131 E. Clarendon Ave., Suite 102. (Please ensure your GPS says Clarendon Avenue, not Street). Parking: The entrance to our parking lot is from 32nd Street (do not turn onto Clarendon).
Questions? If you need help with your forms or getting directions to the clinic, please call our team at (602) 253-9168.
