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(315) 277-2707|Offices in East Syracuse, Fulton and Watertown
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Patient Forms

Patient Formsepcuseadmin2020-12-01T02:46:08+00:00

Discharge Instructions

  • Cardiac Electrical Device & Lead Implantation

  • Cardiac Electrical Device Generator Replacement

  • Electrophysiology Study and/or Radiofrequency ablation

Additional Forms

  • Office Financial Policy & Consent for Disclosure

  • Health Care Proxy

  • New York State Public Health Law Section 18 Access to Patient Records

  • Authorization for Release of Information to Cardiac Electrophysiology Consultants, LLC

  • Medical Records Consent Form

  • Self – Payment Agreement Form

  • Fee for Blood Sent to Laboratory

East Syracuse

6700 Kirkville Road, Ste 203
East Syracuse, NY 13057
P: (315) 277-2707
F: (315) 750-3044

Fulton

810 South First Street
Fulton, NY 13069
P: (315) 277-2707
F: (315) 750-3044

Watertown

1116 Arsenal St, Suite 502
Watertown, NY 13601
P: (315) 277-2707
F: (315) 750-3044
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