Online Forms: (for patients)

• New Patient Letter
• Financial Policy
• New Patient Medical History  (doc)     (html)
• Privacy Policy  (pdf)

Electrophysiology Forms: (pdf)

• ICD Registry 
• EP/Catheter Ablation Post Procedure Instructions
• Pacemaker Defibrillator Discharge Instructions
• Order Form- Outpatient Pacemaker, AICD Insertion
• Order Form- Inpatient Non Invasive AICD Check
• Order Form- Outpatient Non Invasive AICD Check
• Order Form- Insertion of AICD, Permanent Pacemaker
• Order Form- Radiofrequency Ablation, EP Study

Order Forms: (for referring providers)

• Items Needed When Scheduling a Stress Test or Consult
• North Medical General Order Form (pdf)
• Mobile Echo/Vascular Order Form (UMS/VDS) (pdf)
• Northeast Medical General Order Form (pdf)

Patient instructions:

• Exercise Stress Test  (pdf)
• Exercise Nuclear Stress Test  (pdf)
• Adenosine Nuclear Stress Test            
• Dobutamine Nuclear Stress Test
• Stress Echocardiogram
• Dobutamine Stress Echocardiogram
• Echocardiogram
• Transesophageal Echocardiogram  (pdf)     Test description
• Cardiac Catheterization (pdf)                     Test description
• Percutaneous Coronary Intervention (pdf) 

Contact Information

Telephone

315.663.0500 (Fayetteville)  315.701.2170 (Liverpool)

FAX

315.663.0514                     315.701.2186

Postal address

4507 Medical Center Dr. Fayetteville, NY 13066

5100 West Taft Road, Suite 4J, Liverpool, NY 13088

Electronic mail (WE CANNOT RESPOND TO MEDICAL INQUIRIES VIA E-MAIL)

General Information: Fayetteville   pdeberjeois@cvgs.org
                              Liverpool      mschrenko@cvgs.org
 
Webmaster: jdeambra@cvgs.org

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Send mail to: jdeambra@cvgs.org with questions or comments about this web site.
Last modified: 09/04/08