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Services and Treatments

Forms

Print and fill out the following forms before your appointment at Bronx Medical Cardiac:

Bronx Medical Cardiac HIPAA Release Form
This document describes how Medical Information about you may be used and disclosed and how you can obtain access to this. Please read this document carefully so you understand your rights then print, sign and bring to the office PRIOR to your appointment.

View the Bronx Medical Cardiac HIPAA Release Form  

Bronx Medical Cardiac Patient Information Form
Printing this form and filling out PRIOR to your appointment will help save time in the waiting room and help insure that your information is processed accurately. Please make sure all your information is correct and up to date.

View the Bronx Medical Cardiac Patient Information Form

Informacion del Paciente
Informacion del Paciente y Autorizacion para el Seguro Medico  

Ver Informacion del Paciente

Consent & Authorization to Use Medical Health Information
The authorization is written permission from an individual allowing the use or disclosure of specified health information. The following information is provided for: Public Health and Safety; for treatment, payment of health care operations; for research, and more. 

View the Consent & Authorization to Use Medical Health Information Form 

Permission to Perform a Procedure or Test
This is a consent form that authorizes Bronx Medical Cardiac to perform a specific procedure or test for you. Dr. Taviloglu will carefully go through ALL the steps and recommendations so you will have a clear idea of what will be involved and what you can expect.  

View the Permission to Perform a Procedure or Test Form 

Permission to Perform a Stress Echo Test
This is a Stress Test consent form whereby you are giving Dr. Taviloglu permission to perform the test.

View the Permission to Perform a Stress Echo Test Form