Get Summit Cardiology Echocardiography Lab Patient Intake Form

Filling out the Summit Cardiology Echocardiography Lab Patient Intake Form online is a straightforward process designed to ensure that medical professionals have the necessary information about your health. This guide will take you through each section of the form to help you provide accurate and complete information.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date at the top of the form to indicate when you are filling it out.
3. Next, fill in your name, date of birth (DOB), height, and weight in the designated fields. Make sure the information is accurate and clear.
4. Identify the doctor who is ordering the study and provide their name in the respective field.
5. Fill in the name of your primary care physician in the next space provided.
6. If you know the reason for the study, please provide a brief description in the following field.
7. Indicate any symptoms you are currently experiencing by checking the relevant boxes, including options like shortness of breath, chest pain, or palpitations.
8. In the subsequent section, check all past medical conditions you have had, such as high blood pressure, heart attack, or congenital heart defect, ensuring you specify if required.
9. Next, state if you have undergone previous heart surgeries by checking the relevant options. If applicable, identify the type of valve you have and the year of surgery.
10. Review all the information you have filled in to ensure accuracy before completing your submission.
11. Once you have verified your details, you can save the changes, download, print, or share the form as needed.

Prepare your documents and start filling out the form online today!