Requesting a Cardiology Consultation

It is helpful for us to have a few pieces of information about the new patient we will be seeing, in order to give you the best service in the most effective way possible. In addition to demographic and insurance information, what is the specific problem we should address, or question you would like us to answer? If there are any pertinant records, if you could fax these over beforehand, this might save a phone call or two. And if this an urgent consultation, please don't hesitate to call (650.219.1341) and we will be certain to expedite the evaluation.

Ideally, all of this could be done electronically, eliminating the paperwork. Unfortunately, because of patient privacy concerns with internet communication and HIPAA regulations, we still need to rely on a 1985 technology....the fax machine. So please print out the form below, and fax (or mail) to our office.

New patient cardiology consultation request form.