Bay Area Heart
Important! Call 911 if you are experiencing any symptoms of a heart attack.
I authorize payment of medical benefits to the named provider for professional services rendered. I authorize the release of any medical information necessary to process the claim. I understand that I am financially responsible for any balance. I have been given a copy of the patient’s rights and privacy act.
I hereby authorize my test results to be left on the answering machine at the following
I authorize my test results to be given to the following person: