Click on a form below, print it, fill it out and bring it in to the office at your next visit.
- Patient Registration form
- Statement of Patient Financial Responsibility
- Patient Health History
- HIPAA Patient Notification
- HIPAA Patient Signature Form
- PAD Risk Assessment Form
- Blood Pressure/Heart Rate Log
- Medical Records Release Form for Transfer to SoCal Heart Specialists (Pasadena Office)
- Medical Records Release Form for Transfer from SoCal Heart Specialists (Pasadena Office)
- Medical Records Release Form for Transfer from SoCal Heart Specialists to Patient (Pasadena Office)
- Medical Records Release Form for Transfer from SoCal Heart Specialists to Patient (Arcadia Office)
- Medical Records Release Form for Transfer from SoCal Heart Specialists (Arcadia Office)
- Medical Records Release Form for Transfer to SoCal Heart Specialists (Arcadia Office)
Important - Patient Notice
“The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.”
“For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.”