Patient Education

Have you had any recent admission to Hospital relating to your heart?

Have you seen a Cardiologist in the past? *

How did you hear about us? *

Have you had any recent Cardiac related tests

Have you had any recent Cardiac related Procedures

If you indicated any from the above please state: test, clinic/hospital and date

Medications List Do you take the following Medication?

Are you Allergic to anything?

Reason for taking: (e.g. Blood Pressure):

I consent to the release / access by the Rotar Heart Health staff of my medical record to / of any health service provider that requires the information for the purpose of treatment or audit of my current, past or any future conditions.

CARDIOLOGY CENTRE

Kindly click on the link to download the file and print.

BOOK YOUR APPOINTMENT

New patient registration form

Consent to release medical documents