Patient Forms

 

Orlando Heart Center Patients
Patient Questionnaire (.pdf) Patient Questionnaire in Spanish	Patient Consent form (.pdf)
Important Information (.pdf) Important Information in Spanish	Release of Information (.pdf) Release of Information in Spanish
Orlando Health Notice of Privacy Policy (.pdf) Orlando Health Notice of Privacy Policy in Spanish
Diagnostic Testing Patients
Orlando Health Consent form (.pdf) Orlando Health Consent form in Spanish	Orlando Health Financial Policy (.pdf) Orlando Health Financial Policy in Spanish
Vascular Questionnaire (.pdf) Vascular Questionnaire in Spanish	Notice of Limited Liability (.pdf) Notice of Limited Liability in Spanish
Medicare Patients
Medicare Secondary Payer Questionnaire (.pdf)

Print and complete the Financial Policy Statement,  the Patient Information Form, the New Patient Questionnaire, and the Vascular Questionnaire. 

• Bring the completed forms with you on your first visit.  Arrive 30 (thirty) minutes early to review your patient information with our staff. 

• It is important for you to bring all prescription medications in the original containers to your appointment.

• Upon arrival, please have proper identification and insurance cards available for the receptionist.

• Your insurance company may require you to obtain authorization from your primary care physician in order to be seen as a patient at Orlando Heart Center. Please get authorization from your primary care physician prior to your appointment with us if your insurance plan has this requirement. Failure to obtain an authorization number, if required, may result in the postponement of your appointment or all services becoming your responsibility.

  For your convenience, a check list of necessary materials for your appointment with us are listed below: 

  ___   current insurance card(s)	___   prescription medications
  ___   completed information forms	___   signed financial policy
  ___   previous medical records	___   authorization or referral

VERY IMPORTANT: IF YOU NEED TO CANCEL OR RESCHEDULE THIS APPOINTMENT, YOU MUST CALL 48 HOURS PRIOR TO THE APPOINTMENT TIME. IF YOU DO NOT SHOW FOR THE APPOINTMENT OR FAIL TO GIVE 48 HOURS NOTICE OF A NEED TO CANCEL OR RESCHEDULE, YOU WILL BE CHARGED A FEE.