Patient Forms
Please click on the name/type of procedure that you will be having to download patient information forms. These forms provide detailed instructions for you to follow before you have your test at ZCH.
Pre-admitting information is also available and should be reviewed several days before your procedure. Kindly complete these prior to arrival on the day of your procedure.
Cardiopulmonary Services
Cardiology Services
- Cardioversion (22 KB, PDF)
- Echocardiogram (22 KB, PDF)
- Dobutamine Stress Echocardiogram (27 KB, PDF)
- Transesophageal Echocardiogram (TEE) (23 KB, PDF)
- EKG (Electrocardiogram) (22 KB, PDF)
- Exercise Stress Test (GXT) (30 KB, PDF)
- Nuclear Stress Testing (Cardiac Perfusion Stress Test) (26 KB, PDF)
Neurology Services
- EEG (Electroencephalogram) (25 KB, PDF)
Pulmonary Services
- Pulmonary Function - Complete (22 KB, PDF)
- Spirometry Screen (with or without bronchodilator) (22 KB, PDF)
- Inhalation Challenge (Methacholine) (25 KB, PDF)
Laboratory
- Blood Transfusion (28 KB, PDF)
- Collecting a Urine Sample (89 KB, PDF)
- Collection of Stool for Occult Blood (107 KB, PDF)
- Drug Medication Level Lab Test (103 KB, PDF)
- Fasting Instructions (21 KB, PDF)
- Glucose Tolerance Test (100 KB, PDF)
- Menu for 2-hour Postprandial Blood Sugar (16 KB, PDF)
- Semen - Post Vasectomy Collection (110 KB, PDF)
- Stool Collection (112 KB, PDF)
- Urine Test (24 hour) (121 KB, PDF)
Health Information Services (Medical Records)
- Request for Records of Deceased Person (133 KB, PDF)
- Authorization for the Release of Medical Information (89 KB, PDF)
The Diabetes Center
- Referral Form (56 KB, PDF)
Surgery
- Surgery Brochure (293 KB, PDF)
Radiology
- Barium Enema (24 KB, PDF)
- Bone Densitiometry (22 KB, PDF)
- Colon X-ray (under 14 years) (30 KB, PDF)
- CT Scan (26 KB, PDF)
- IVP (under 14 years) (27 KB, PDF)
- IVP (24 KB, PDF)
- UGI (21 KB, PDF)
- Ultrasound (25 KB, PDF)
