Summit Cardiology Compassion and Knowledge: The Heart of Excellence in Care Summit Cardiology Compassion and Knowledge: The Heart of Excellence in Care :(206) 363 1004
 
 
Appointments

Patient Forms

Registration Form   Registration form

REGISTRATION FORM: Please complete this form if you are a New Patient to Summit Cardiology.

Clinical Intake Form   Clinical Intake Form (LONG VERSION)

INTAKE FORM (LONG VERSION): Please complete this form if you are a New Patient here for any of the following reasons:

  • Consultation with our cardiologist
  • Nuclear stress test
  • You have not been seen at Summit Cardiology in the past 3 years.

Registration Form   Echo Intake Form

Registration Form   Vascular Intake Form

ECHO & VASCULAR INTAKE FORM: Please complete this form if the following applies to you:

  • If you are a New Patient here for an echo, stress echo test or vascular study only with no provider followup scheduled, please use this intake form.
  • If you are scheduled for two studies, please complete one form only. Please complete the vascular intake form if you are scheduled for an echo or a stress echo test and a vascular study.


Release of Information Forms

Please complete this form if you would like Summit Cardiology to release records to you or an appointed guardian or if your provider requires you to sign a release for your records to be sent to Summit Cardiology.

Patient Authorization for UW Medicine to Disclose/Release Protected Health Information   UW Medicine Authorization to Obtain Release Information Form

 

 

 

 

 


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