Online Forms

Online Forms

Whether you are a current or prospective patient at Centra Medical Group Stroobants Cardiovascular Center, this page will assist you in finding helpful information. If you have questions about the online forms or any additional information you may need to remember to bring for your appointment, please call our office for assistance.

Cardiac Test Instructions

Cardiac Test Instructions
Cardiac Test Instructions

Stress tests can be performed for many reasons, but they all evaluate the health of your heart muscle. A stress test can have one or two parts. The first is a stress portion (accomplished through either exercise or medication), and the second is an ultrasoundtakes pictures of your heart both before and after the stress portion.

Patient Instructions for Stress Echo/Stress Test

The heart is a special muscle that needs its own blood supply. This study determines blood flow to the heart muscle. Low blood flow can cause the muscle to function poorly, so this test also looks at how well the heart is squeezing. A small amount of nuclear imaging material is given through an IV and is absorbed by the heart muscle. Our special cameras can tell how well this material is absorbed by the heart. We get two sets of pictures — the first while the heart is at rest and another after the heart is stressed. Our cardiologist then compares the two sets of pictures. 

Patient Instructions for Cardiovascular Tests

A cardiologist will review the results of your test, and the report will be sent to your primary care physician. He/she will advise you of the results. 

Patient Instructions for Nuclear Stress Test

HIPPA Form

HIPPA Form
HIPPA Form

The online HIPPA form provides consent to the use and disclosure of health information for treatment, payment, or healthcare operations.

HIPPA Form

Pre-Catheterization and Defibrillator Information

Pre-Catheterization and Defibrillator Information
Pre-Catheterization and Defibrillator Information

This online form provides helpful information prior to a cardiac catheterization, permanent pacemaker, or defibrillator.

Instructions

Medical Release Records (to release to another doctor)

Medical Release Records (to release to another doctor)
Medical Release Records (to release to another doctor)

Please print, read carefully, and fill out this form in order for Stroobants Cardiovascular Center to release your medical records to another medical practice.

Medical Release

Please return the completed form to our office at:
Stroobants Cardiovascular Center
2410 Atherholt Road
Lynchburg, VA 24501
Fax number: 434.544.2312

Medical Release Records (to send records to Stroobants Cardiovascular Center)

Medical Release Records (to send records to Stroobants Cardiovascular Center)
Medical Release Records (to send records to Stroobants Cardiovascular Center)

Please print, read carefully, and fill out this form in order for Stroobants Cardiovascular Center to obtain your medical records from an outside medical practice.

Medical Release

Please return the completed form to your medical practice. Stroobants Cardiovascular Center can also contact your physician's office once we have the completed form.

Stroobants Cardiovascular Center
2410 Atherholt Road
Lynchburg, VA 24501
Fax number: (434) 544.2312