Please print and fill out the following forms prior to your first office visit.
(To download the forms right click and select “Save Link As.”)
Feghali Cardiology Office Forms

Form 1: Patient registration, patient needs to complete all of the form front and back.
Form 2: Health History, this form is vital for current symptoms, medical history, medications, family history, current conditions,  also needs to be completed front and back.
Form 3: Medical Release form, the patient only needs to sign and date the bottom, this form is used to request medical records from other physicians.
Form 4: Patient Record of Disclosures, this form used for HIPAA purposes, lets SFC know how to contact the patient and what medical information can be released. The patient needs to complete the top half of the form, note Other box is used for another person that can receive information pertaining to the patient. (ex. Spouse or parent).
Form 5: Financial policy of SFC, patient needs to read front and back,  print and sign the back portion.
Form 6: HIPPA Notice, patient privacy act, the patient needs to read front and back, print and sign the back portion.