Call at:
(07) 5578 6866
Email us:
info@cardiacdynamics.com.au
About Us
Our Typical Patient
Our People
Cardiac Assessment Center
Diagnostic
Symptoms
Angina
Breathlessness
Circulation
Fatigue
palpitations
Tests & Technologies
Automated Office BP
ECG (Electrocardiograph)
Echocardiography
Exercise Stress Test
Holter Monitor Wireless (RootiRx)
Our Services
Risk Factors
Abdominal Obesity
Cholesterol
Diabetes
Exercise-The Lack Of It
Smoking
Blood Pressure
Cancellation Policy
Contact
New Patient Details
New Patient Details
Home
New Patient Details
Title
*
Mr
Mrs
Ms
Miss
DOB
*
Surname
*
Preferred Name
*
Given Name
*
Address
*
Suburb
*
Postcode
*
Home Phone
Mobile Number
*
Email
*
Marital Status
*
Medicare Number
Patient Number
Expiry Date
Pensioner/Health Care or Vet Affairs Card Number
Health Insurance/Fund
Next of kin & Emergency Contact
Name
Relationship
Contact Number
Medical Details
Referring Doctor
Regular GP
Allergies (if any)
Family History (if any)
Do you smoke?
Yes
No
If yes, how many a day?
Years
Do you drink alcohol?
Yes
No
If yes, how many a day?
How many a week?
Medication/s (if any)
How did you hear about us?
Newspaper Ad
Radio
Internet
Other
From our patients
To assist with health initiatives do you wish to self identify as:
Aboriginal
Torres Strait Islander
Other
