The following checklist describes the information we require from you before or during your initial examination. Please be prepared with this information for your first visit. In some cases you may be required to mail this information ahead of time. Any information you send to the Cleveland Clinic Foundation should be clearly marked with your name, address, and phone number, and sent via Airborne Express, Federal Express, or Certified U.S. mail (make sure you have a tracking number):

Information about your referring or primary physician:

• Name
• Address
• Phone Number
• Fax Number (if applicable)
• Email (if applicable)

Information about you:

• Name
• Birthdate
• Address
• Phone Number
• Email (if applicable)
• Social Security Number
• Insurance information - please bring your insurance card with you
• Questions for your doctor - please prepare a list of specific questions that you would like to ask

Your complete Medical History and Records

• Bring your original medication containers. Also include all vitamins, herbals, or over-the-counter pills or remedies. This helps avoid confusion over dosages and names of your current medical program.
  
• Bring the discharge summaries from any recent hospital stays (within the past 3 to 5 years).
  
• Make a list of any devices (such as a pacemaker) and the type and settings that have been prescribed for
  you, if known.
  
• If you have had any of the following diagnostic tests or procedures, please obtain the actual tests (films
  or tracings) and reports from your outside doctor. Bring this information with you, or mail it ahead of
  time via overnight mail or express mail to your Cleveland Clinic Heart Center doctor.
  
  • Operative notes from previous heart surgeries
    
  • Cardiac catheterization: actual film plus report
    
  • Echocardiogram: report plus actual film (video tape or CD-ROM are fine)
    
  • Thallium stress test: actual x-ray film plus report
    
  • Chest x-ray, CT scans, ultrasounds: x-ray films plus report
    
  • Electrocardiograms: actual tracings, if available
    
  • Electrophysiology testing: actual tracings and reports

Other important information to prepare for your visit:

• You will receive an appointment schedule in the mail prior to your visit. If your visit is scheduled within two days of your appointment, you will receive your written schedule when you arrive at the Heart Center.
• You are encouraged to bring a family member or friend on the day of your appointment, though it is not absolutely necessary.
• Take all of your medications as prescribed, unless you have been given other instructions. If you have diabetes, ask for specific diet and medication instructions.
• The time you are asked to report for your appointment or procedure includes the time necessary to provide you with additional instructions and preparation. This may result in a delay in your procedure time or a delay in seeing your physician. It is our commitment to provide each patient with the best care. We will do our best to make sure that you and your family members are as comfortable as possible during your stay.
• For parking information, click here
• Please report to Desk F-12, the Heart Center Welcome Desk, to start your appointment. This is located on the first floor of the F Building adjacent to the Main Hospital Lobby (H Building). Please show the receptionist the enclosed appointment schedule and insurance information. For a map, click here
• If this is your first visit, please plan on being at The Cleveland Clinic Foundation for four hours.
• If You Have Questions or Need to Reschedule Your Appointment, please contact the Appointment Office as soon as possible.
  

Rev. 4/03