St. Luke's University Health Network

Patient Forms

Patient Forms

Our staff is committed to providing excellent care in a patient-friendly environment. Our team of physicians and nurse practitioners offer you the most experienced cardiology care in the Lehigh Valley and surrounding counties.

1. Please download, print and complete the forms featured below. ALL of the information is important, so please DO NOT leave any blanks.

2. Please arrive 30 minutes early to finalize all paperwork prior to your visit.

3. Be sure to bring the following to your appointment:

  • The completed Patient Information form
  • Your insurance card(s)
  • Co-pay if required
  • Referral from the physician who is sending you here, if required by your insurance
  • Any and all prior lab work, diagnostic testing (Stress Test, Echo, Cath, Open Heart Surgery, etc.)
  • All medication bottles

4. Your insurance may require you to pay a co-pay at the time of your visit. We will accept cash, personal check or credit card.

5. It is our office policy to reschedule any appointments if:

  • The co-pay is not paid at the time of service
  • You do not have your insurance referral
  • Your records have not arrived.

If you have any questions, please feel free to call one of our offices.

Download, print and complete the following forms:

New Patient Information

Insurance Authorization

Release of Health Information

Financial Policy

Financial Liability Acknowledgement

Notice of Privacy Practices and Signature Sheet