Kinesiologist appointment

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Menu

About
Services
Physicians
Patients
Virtual Care
Pay Online
- Pay Now
- Uninsured FAQs

Menu

About
Services
Physicians
Patients
Virtual Care
Pay Online
- Pay Now
- Uninsured FAQs

3080 Yonge Street Suite 4022

Toronto, Ontario M4N 3N1

admin@lpcardiology.com

If contact information is not provided, patient will not be contacted.

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PATIENT NAME

ADDRESS

DATE OF BIRTH

GENDER

F
M

EMAIL ADDRESS *

HOME PHONE NUMBER *

CELL PHONE NUMBER *

PATIENT

KINESIOLOGIST SERVICES

Initial consultation (60 minutes)- $150
Follow-Up Visit (45 minutes) - $120
Package 1 - 3x45 f/u sessions - $145
Package 2 - 5x45 fu sessions - $5740
Package 3 - 6x45 f/u sessions + initial dietitian consultation - $835

REASON FOR VISIT

Recovering from heart attack, angioplasty, bypass surgery, or valve surgery
Stable angina, heart failure, high blood pressure, or high cholesterol
Seeking medically guided exercise under cardiologist supervision
Other

PATIENT NAME

ADDRESS

DATE OF BIRTH

GENDER

F M

HEALTH CARD NUMBER

VERSION CODE

EMAIL ADDRESS

HOME PHONE NUMBER

CELL PHONE NUMBER

CLINICAL EVALUATION

Consultation Consult, if abnormal Neuro-Vascular, Stroke, TIA Clinic Hypertension & Diabetes Internal Medicine & Geriatrics Dietician Consultation

REASON FOR VISIT

TESTS REQUIRED

Treadmill Stress Test Echocardiogram Stress Echo 12 Lead ECG 24 HR ABP Monitor (not covered by OHIP)

w/contrast w/contrast

HOLTER MONITOR (Indicate one)

24hr 48hr 72hr 96hr 7 days 14 days

PROVIDERS

First Available Dr. Eugene Crystal MD, FRCPC Dr. Ilan Lashevsky MD, FRCPC Dr. Alex Crystal MD, FRCPC

Dr. Mina Madan MD, FRCPC Dr. Ashish Patel MD, FRCPC Dr. Tasnim Vira MD, FRCPC

Dr. Romana Dragojevic MD, GIM & Hypertension Dr. Houman Khosravani MD Dr. Christopher Lewis MD, GIM & Geriatrics

REFERRING PHYSICIAN

PHYSICIAN NAME

PHYSICIAN NUMBER

PHYSICIAN FAX

PHYSICIAN EMAIL

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