Patient Checklist

800.659.7822 Toll Free

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 should be clearly marked with your name, address, and phone number, and sent via a carrier that provides you with a tracking number, such as DHL, Federal Express, or certified U.S. mail.

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
  • Picture ID - drivers license or state ID
  • 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 Miller Family Heart & Vascular Institute 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 Miller Family Heart & Vascular Institute at Cleveland Clinic.
  • 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.
  • Please report to Desk J1-3, the Miller Family Heart & Vascular Institute Registration Desk, to start your appointment. Please show the receptionist the enclosed appointment schedule and insurance information.
    Get locations and directions and parking information.
  • If this is your first visit, please plan on being at Cleveland Clinic for four hours.
  • If you have questions or need to reschedule your appointment, please contact the Appointment Office as soon as possible.

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.

Schedule an Appointment

Toll-free 800.659.7822

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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