650 Peter Jefferson Parkway, Suite 100
Charlottesville, VA 22911
Office: (434) 293-4072
Fax: (434) 293-4265
Prior to your appointment, you can view and download our new patient paperwork. Please complete the Patient Information and Medical Screening Form and the Medical Records Release Authorization. Bring them with you to your first visit. The forms need to be completed by the patient or legal guardian. Note: These forms are provided in PDF format and requires Adobe Reader to open and view (click here to download Adobe Reader).
1. PATIENT INFORMATION FORM This form is used to provide our office with the patient's personal and insurance information. Your medical history will be reviewed by our cardiologists. The form also gives your consent to receive care, and for our office to release medical information to your primary care doctor or others, when needed.
2. MEDICAL RECORDS RELEASE AUTHORIZATION This form allows our office to request your medical records from your other doctors or other medical facilities.
Please arrive 30 minutes before your appointment, and bring:
Here is a website link that may be helpful to you before your appointment:
Be Prepared for Medical Appointments - http://www.ahrq.gov/questionsaretheanswer/
The following notice describes how medical information about you may be used and disclosed and how you can get access to that information.