Healthy Hearts Patient Information

  • Date Format: MM slash DD slash YYYY
  • I authorize CARDIOVASCULAR CONSULTANTS MEDICAL GROUP physicians and staff to disclose to and discuss my protected health information with the following (e.g. family member, friend) person or persons in addition to my other health care providers
  • I authorize CARDIOVASCULAR CONSULTANTS MEDICAL GROUP physicians and staff to disclose to and discuss my protected health information with the following (e.g. family member, friend) person or persons in addition to my other health care providers
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY