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Forms for your Convenience

We know that you have many choices when it comes to your cardiovascular care, and we thank you for choosing The Texas Heart Institute Center for Cardiovascular Care. Our professional staff is dedicated to high-quality individualized care for each of our patients, using a patient-focused approach that is designed to promote your long-term health and wellbeing. The following information will assist you in making your visit with us as convenient and pleasant as possible.

New Patient Forms

  1. Welcome to The Texas Heart Institute Center for Cardiovascular Care
  2. Medical History / Medication Sheet
  3. Notice of Privacy Practice
  4. Aviso de prácticas de privacidad (Notice of Privacy Practice in Spanish)
  5. Patient Demographics Sheet
  6. Patient History Questionaire for Cardiovascular Surgery (For Patients of Drs.  Cozart, Hallman, Livesay ONLY)
  7. In-Office Testing Instructions & Details
  8. Financial Responsibility Contract
  9. Authority to Release Protected Health Information

Established Patient Forms

  1. Medical History / Medication Sheet
  2. Patient Demographics Sheet
  3. Financial Responsibility Contract
  4. In-Office Testing Instructions & Details

Miscellaneous Forms

  1. Authorization to Release Protected Health Information (Drug and/or Alcohol abuse, and/or Psychiatric, and/or HIV/AIDS records release)
  2. Authorization to Release Protected Health Information (Records Release)

Physician Referral Forms

  1. Physician Referral Form