Florida Heart Group: Referring Physicians

We value our Referring Physician Partners!

Thank you for choosing the Florida Heart Group for your patient's cardiac needs. You can fill out the following online form to request consulations, testing, or procedures.

You can also click HERE to download the PDF version of this form if you prefer to fill out and fax the form instead.

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Click here for a free download.

Referring Physician:

Phone:

Patient Name:

DOB:

Diagnosis:

Insurance Company:

Patient Contact Numbers:

Home

Cell

Work

Patient is being referred to Florida Heart Group for:

Consultation Only (Fax all current and/or relevant labs, office notes, EKG, and any cardiac-related diagnostic exams)

New Patient Evaluation (Fax all current and/or relevant labs, office notes, EKG, and any cardiac-related diagnostic exams)

Vein Center Consult

Testing Only (check appropriate boxes below)

Carotid
Echo 2D m-Mode
Venus Doppler	Arterial Doppler	Peripheral Doppler
(Upper Ext Lower Ext ) (Bilateral Unilateral )
Stress Test – Cardiac PET
Stress Test – 2 Day Cardiolite (Check appropriate box below)
Treadmill Stress Adenosine Stress
Exercise Stress Test (Treadmill)
Holter Monitor
Other

Request Specific Physician

Jose Arias, MD

Alejandro Franceschi, MD

Carol Ma, MD

Kerry Schwartz, MD

Rohit Bhatheja, MD

Patricia Guerrero, MD

Mark Milunski, MD

Hani Seifein, MD

Puxiao Cen, MD

Harischandra Karunaratne, MD

James Miner, MD

Curtis Weaver, MD

R. Charles Curry, MD

Chin Kim, MD

George Monir, MD

William Willis, MD

Francis Fahey, MD

Hector Lozano, MD

Carlos Saenz, MD

Click "Submit" to send. Once received, patients will be contacted and scheduled as indicated above.