Southern Tennessee Cardiology and Vein Center

PATIENT DOCUMENTS

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will be happy to assist you with your questions on the day of your visit.

Download Patient Forms

Patient Consent Form

Patient Financial Responsibility Form

Disclosure Agreement

Patient Privacy Notice

Patient Privacy Practices

CANCELATION POLICY

YOUR APPOINTMENT TIME IS RESERVED EXCLUSIVELY FOR YOU.

If you are unable to keep your appointment, kindly call us with at least 24 hours notice. This courtesy, on your part, will make it possible to give your appointment to another person. In the event you cancel within 24 hours of your appointment, we will charge a cancellation fee of

$25 for Office Visits

$50 for Testing

$150 for Nuclear Stress Tests.

Kindly note the higher fee for office procedures. Testing slots are especially difficult to fill on short notice because of required insurance authorizations and regulatory requirements. Additionally, nuclear stress tests require us to purchase a medication specifically for you and your designated appointment time. If we are unable to cancel this medication order, the cost will be billed directly to the patient and is not billable to insurance.

PATIENT DOCUMENTS

Download Patient Forms

CANCELATION POLICY

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