Phone: 908-923-4499 | Fax: 908-923-4011
Home
About
About SCC
Dr Starcevic – Cardiologist
Testimonials
Team
Services
Conditions
Forms & More Info
Authorization to Bill Insurance Form
HIPAA Notice Form
Notice of Privacy Practices Acknowledgement Form
Patient Demographic Form
Insurances We Accept
Contact Us
Menu
Star Cardiology Care, PC
403 Route 202 South, Suite 200
Flemington, NJ, 08822
Download PDF Printable Form
Consent
*
I agree to the privacy policy.
By signing, I acknowledge that I am aware of the existence of the Notice of Privacy Practices posted in the reception area of the Star Cardiology Care, PC. I may review this Notice at any time during my visit.
Patient Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Signature
*
Date
*
Date Format: MM slash DD slash YYYY
Scroll to top