East Coast Cardiology & Vein Clinic 904.296.7775
East Coast Cardiology & Vein Clinic                                     904.296.7775

Patient Forms

Want to save time during your visit with us? Please print and fill out the following forms and bring with you on your first appointment.

Don't forget to bring your insurance card and a picture id with you. 

In order to register and treat you promptly, we request that our patients bring their current medications with them to each appointment.  Make sure to bring the medications in their original bottles so that we can accurately document dosage and prescribed taking. 

We accept most types of health insurance. Please contact us for further details.

HIPAA Form
HIPAA Form.docx
Microsoft Word document [21.4 KB]
NOTICE OF PATIENT PRIVACY PRACTICES
NOTICE OF PATIENT PRIVACY PRACTICES.docx
Microsoft Word document [22.4 KB]
New Patient Paperwork
New Patient Paperwork.docx
Microsoft Word document [88.5 KB]
New Venous Patient History Form
New Venous Patient Health Form.docx
Microsoft Word document [19.3 KB]
Auth for Release of Records
HEALTHCARE STATUS AUTHORIZATION.docx
Microsoft Word document [13.3 KB]

Important telephone numbers for in case of emergencies:

Emergency Services & Fire Department 911
Centers for Disease Control and Prevention

800-CDC-INFO

(800-232-4636)

Memorial Hospital (904) 391-6111
St. Vincents Southside Hospital (904) 296-3700
Baptist Downtown (904) 202-8000

Call us today to schedule an appointment!

East Coast Cardiology, P.A.

8245 Bayberry Road

Jacksonville, FL  32256

 

Ph:  (904) 296-7775

Fax:  (904) 296-7760

referrals.ecc@gmail.com

 

Or use our contact form.

Office Hours

We are open Monday thru Thursday - 8:00am to 4:30pm

Fridays 8:00am to 1:00pm

Connect With Us

Follow us on Twitter:  EastCoastCardio

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