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Patient Form to Set Up Appointment

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PLEASE FILL IN INFORMATION FOR A PATIENT EVALUATION

Please fill out the following form to set up an appointment or call 214-774-9771

Reason for Visit

Thanks for submitting!

Please call to confirm or with any questions - 214-774-9771

© 2014 by Advanced Heart and Rhythm, PLLC

3650 W. Wheatland Rd. Suite C, Dallas, TX 75237

Tel: 214-774-9771

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