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®

FOR REFERRING PHYSICIANS

Physicians, below you will find a series of documents in PDF form.

Download the form, open the form and print, fill in the necessary information and have your patient bring to their next appointment.

ORDERING SERVICES

Foothill Cardiology Heart Logo

This form is for ordering diagnostic tests that are provided by Foothill Cardiology.

TO FC

ARCADIA

COVINA

PASADENA

Please select from the list at right to download the form for the correct office location:

Foothill Cardiology Heart Logo

Information for PRE-TEST patients who will be undergoing Myocardial Perfusion PET Imaging.

FROM FC

Click to download the document

DOWNLOAD

AUTHORIZATION FOR RELEASE AND / OR
DISCLOSURE OF MEDICAL INFORMATION

Completion of these documents authorizes the disclosure and/or use of individually identifiable health information, asset forth below, consistent with the Confidentiality of Medical Information Act of 1981, Civil Code Section 56 et seq,concerning the privacy of such information.

OTHER FORMS

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Request for Foothill Cardiology patient medical information to be released to outside sources.

FROM FC

Click to download the document

DOWNLOAD

Foothill Cardiology Heart Logo

Request for patient medical information to be released to Foothill Cardiology.

TO FC

Click to download the document

DOWNLOAD

© 2023 Foothill Cardiology Medical Group, Inc. All rights reserved.

CONNECTIONS

ARCADIA

Phone: 626.254.0074

289 W. Huntington Drive

Suite 401

Arcadia, CA 91007

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COVINA

Phone: 626.915.4700

235 E. Badillo St.

Covina, CA 91723

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PASADENA

Phone: 626.793.4139

625 S Fair Oaks Ave
Suite 215
Pasadena CA 91105

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GLENDORA:

Phone: 626.915.4700

552 W. Foothill Blvd
Suite 201

Glendora, CA 91741

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Administration OFFICE:

Phone: 626.793.2885

235 E Badillo Street

Covina, CA 91723

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BUSINESS OFFICE:

Toll Free: 1-877-943-2823

235 E Badillo Street

Covina, CA 91723