New Patient Forms

Thank you for making an appointment with Legacy Heart Center. Your medical history is a very important part of the doctor’s evaluation.

Please fill out and submit the New Patient Questionnaire online. This will speed up your processing once you arrive for your appointment. If you have problems with the online version of the New Patient Questionnaire, please click here to open a PDF version that you can print and fill out.

Complete ALL questions to the best of your ability. If you do not know exact answers or dates to some of the questions, please answer as best you can. If a question does not apply to you, please mark “N/A” for not applicable.

Please print out, initial and sign the Authorization for Disclosure of Medical Information and bring it with you to your first appointment or fax it to 469-326-3441 Attn: Intake Department.