Downloads

New Patient Forms


Patient Registration Form
Golden Empire Cardiology’s Patient Registration Form.

Download


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..

Download


Privacy Policy 
Golden Empire Cardiology’s Privacy Policy.

Download


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.

Download


Financial Policy 
Golden Empire Cardiology’s financial policy pertaining to your medical insurance and financial responsibility for services provided by Golden Empire Cardiology

Download

Other Forms


Nuclear Preparation Form 
Pre-procedure preparation and a explanation of what to expect during a Thallium stress test.

Download


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.

Download


Stress Testing Information 
Important information regarding your Treadmill Stress Test & Stress Echocardiogram.

Download


Dobutamine Echocardiogram Information 
Important information regarding your Dobutamine Echocardiogram.

Download