HEARTPLACE WHITE ROCK

HeartPlace White Rock is conveniently located in Dallas, TX near White Rock Lake. We have a wonderful group of physicians ready to serve you. Call us today for your appointment. We look forward to meeting you and starting your journey to a healthy heart.

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9330 Poppy Drive

Suite 302
Dallas, Texas 75218

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Phone: 972-276-8994
Fax: 844-292-1462

Location Hours: 8:00 am - 5:00 pm (Monday - Friday)

White Rock Clinic Providers

White Rock 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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White Rock Clinic Fax #: 844-292-1462

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

• Holter Monitor Diary

• Referral Request (from a provider)

Patient Testing Instructions

• Stress Test

• Echocardiogram

• Stress Echocardiogram

• Nuclear Stress Test

• Abdominal Aorta Ultrasound​

Patient Procedure Instructions

BEFORE PROCEDURE​

• Pacemaker

• ICD/Defibrillator

• Cardioversion

• TEE

• Cardiac Catheterization

POST PROCEDURE​

• Pacemaker

• ICD/Defibrillator

• Angioplasty/Stent

• Open-Heart Surgery