Please remember to have the following information with you when visiting our office: Your Current Address, Phone Numbers, Social Security Number, Driver's License/State ID and Insurance Information. We ask that you also bring a list of any and all medications you are taking.
Click on the links to download our forms.
New Patient Forms |
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| New Patient History | Patient Demographics | |
Office Procedure Instructions |
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| Echocardiogram, Exercise Stress Test, Holter Monitor | Stress Thallium | |
| Persantine Thallium | Dobutamine Stress | |
Hospital Procedure Instructions |
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| Cardiac Catherization Scheduled At Henry Medical Center | Cardiac Catherization or Procedures Scheduled at Southern Regional Medical Center | |
| Cardiac Catherization or Procedures Scheduled at Piedmont Hospital | Cardiac Catherization or Procedures Scheduled at Emory Midtown | |
| Pacemaker Implant Instructions | Defibrillator Implant Instructions | |
| NIPS Intructions | EP Study/Ablation Instructions | |
| Bi-V Implant Instructions | ||
Miscellaneous Forms |
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| Release of Information | Forms Completion | |
Dr. Gupta Electrophysiology Forms |
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| Bi-V Implant Instructions | NIPS Intructions | |
| Defibrillator Implant Instructions | Pacemaker Implant Instructions | |
| EP Study/Ablation Instructions | ||
Do You Need an Interpreter? |
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| Interpreter Services | ||
Contact us to receive more information
about how we can help you!
770-692-4000Click Here
