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ICAEL

Patient Forms
For your convenience, we have provided the following forms. Please print, fill out, and bring all necessary forms to our office at your next appointment. If you are not sure which forms you need to bring, please feel free to contact our office.

Patient Registration Form
Each new patient is required to complete this registration form prior to being seen by one of our specialists. If you plan on filling this form out at our office, please show up 1/2 hour prior to your appointment.

New Patient History Form
Your medical history is very important as it helps alert us to any potential problems that might interfere with your surgery. Please take the time to fill this form out completely and accurately. The information will be kept confidential. If you need help, our staff can assist you.

Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Medical Records Release Authorization Form
Need to get a copy of your medical records? Print a copy of our Medical Records Request Authorization Form. For instructions and where to mail, please click here.

Authorization for Release of Information
Authorization form for Los Angeles Cardiology Associates to release your medical information.

New patients, please click here for further information.


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