HEARTPLACE ALLIANCE-KELLER

HeartPlace Alliance is located in Keller, TX, just Northeast of downtown Ft. Worth. We have a wonderful physician ready to serve you. Call us today for your appointment. We look forward to meeting you and starting your journey to a healthy heart.

Click Here for Detailed Location Map

721 Keller Parkway

Suite 107-B

Keller, Texas 76248

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Phone: 817-284-3915
Fax: 844-292-1464 

Hours: 1pm-5pm (Wednesday)

Alliance Clinic Providers

Alliance Clinic Forms

For your convenience, we have placed various patient forms below, in the form of PDF files that you may download at your leisure. Once they have been completed, you can either mail or fax them to this office, or bring them with you to your appointment.

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Alliance Clinic Fax: 844-292-1464

You will need the Adobe Reader to view and print these documents.

Full Patient Visit Packets

• New Patient Packet

• Established Patient Packet​

Individual Patient Visit Forms

• Patient Demographics Form

• Patient Privacy Notice (HIPAA)

• New Patient Questionnaire

• Established Patient Questionnaire

• Authorization For Release of Medical Records TO HeartPlace

• Authorization For Release of Medical Records FROM HeartPlace

• Blood Pressure Log

Patient Testing Instructions

• Stress Test

• Echocardiogram

• Stress Echocardiogram

• Nuclear Stress Test - AM Appointment

• Nuclear Stress Test - PM Appointment​

• Abdominal Aorta Ultrasound​

Patient Procedure Instructions

POST PROCEDURE​

• Pacemaker

• ICD

• Angioplasty/Stent

• Open-Heart Surgery