New Patient Forms
Patient Registration Form
Golden Empire Cardiology’s Patient Registration Form.
Personal History Form
Your health history is an important component to your evaluation here at GEC. Completion of this form provide our physicians with key information about your history to assist in appropriate evaluation and treatment of your cardiac condition..
Acknowledgment of Privacy Form
How your medical information is communicated to yourself, family and other designated persons is important to GEC. Providing authorization ensures we are following your requests. Given the strict HIPPA guidelines today, GEC cannot share your information without a signed privacy form.
Golden Empire Cardiology’s financial policy pertaining to your medical insurance and financial responsibility for services provided by Golden Empire Cardiology
Nuclear Preparation Form
Pre-procedure preparation and a explanation of what to expect during a Thallium stress test.
Disclosure Authorization Form
A form to authorizing your previous physicians to provide Golden Empire Cardiology with your medical records to help assist in your evaluation.
Stress Testing Information
Important information regarding your Treadmill Stress Test & Stress Echocardiogram.
Dobutamine Echocardiogram Information
Important information regarding your Dobutamine Echocardiogram.