Forms

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These are the forms that the doctor will need at least 3 days before your visit.  It is important that we get them 3 days before your visit so the doctor has a chance to review them and make notes before you come in.  Please print them out, complete them, and then either scan them into a computer and email them to us at info@heartcare1.com or fax them to us at 303-499-1054, or mail them to: 

Heart Attack Prevention Strategies
5330 Manhattan Circle, Suite A
Boulder, CO 80303

 

pdfDemographics Form

pdf Doctor Information Form

pdfEpworth Sleepineess Scale

pdfMedical History

pdfMedicare Patient Private Contract

pdfPatient Welcome Letter

pdfPolicies and Consent

pdfSelf Rating Test

 


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Please call for your appointment today, 303.554.4353.