Cardiac Rehab Patient Forms
If you are a new Cardiac Rehab patient, please read these General Instructions before you attend orientation.
New Patient Forms
To help our team of cardiac rehab experts get to know you, your specific cardiac condition, level of activity and important health indicators, please click on the following links to print and fill out each form. Please bring these forms with you to your orientation appointment.
- About You
- About You - for valve patients only
- Dartmouth COOP
- Duke Activity Status Index Survey (DASI)
- General Cardiac Rehab Information
- Know Your Risk Factors
- Quality of Life Index
- Patient Health Questionnaire (PHQ9)
- Patient Learning Priorities
- Rate Your Plate
- Sleep Apnea Evaluation Form