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10243 Yonga Street, Richmond Hill, ON L4C 3B2
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CALL US NOW :
(905) 884-0904
FAX US:
(905) 884-3094
MAILING ADDRESS :
rhsdus@gmail.com
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Services
Ultrasound
Echocardiography
Holter Monitor
Stress Echo
Vascular Ultrasound
Ambulatory BP Monitor
Patient History Form
FAQs
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Home
About Us
Services
Ultrasound
Echocardiography
Holter Monitor
Stress Echo
Vascular Ultrasound
Ambulatory BP Monitor
Patient History Form
FAQs
Requisitions
Contact Us
Book an Appointment
Patient History Form
First Name
Last Name
Phone Number
Date of Birth
Please list all of your current medication with their doses.
Text Area for Medication
Please list any surgery you have had and when.
Text Area for Surgery
In you DIRECT family (parents and siblings), does anyone have:
Blood Pressure
High Blood Pressure
Text Area for Blood Pressure
Diabetes
Diabetes
Text Area for Diabetes
Heart Attack
Heart Attack / Bypass Surgery
Text Area for Heart Attack
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