How would you like to schedule?

Choose the option that works best for you.

📞 Call the Office (305) 529-9901

Are you a new or returning patient?

New Patient Returning Patient I am not sure

Patient Information

This information is required to schedule your visit.

First name *

Middle name (optional)

Last name *

Date of birth *

Gender *

Preferred language *

Marital status (optional)

Address *

City *

State *

ZIP code *

Primary phone number *

Secondary phone (optional)

Email address *

Emergency Contact

Name *

Phone number *

Relationship *

Pharmacy

Pharmacy name

Pharmacy phone

Referred by (optional)

Primary Care Provider Information

I do not currently have a primary care provider

PCP first and last name

PCP practice / clinic name

PCP phone number

PCP fax (if known)

PCP address (optional)

Insurance Information

Insurance company

Plan name

Member / policy number

Group number (if applicable)

Subscriber name

Subscriber date of birth

Relationship to subscriber

Insurance Card & Photo ID

Use your phone camera or choose a file. Accepted: JPG, PNG, HEIC, PDF.

Referral Review

Your insurance plan may require a referral or authorization. Our team will review your information and contact you if anything additional is needed.

If you have any of the following, you're welcome to upload them now — but it's fine to continue without them.

Have you been admitted to a hospital or visited an emergency room within the last three months?

Yes No Prefer to complete this at the office

What is the main reason for your appointment?

Select an Office Location

Select an Appointment Date and Time

Your selected date and time are being submitted as an appointment request. Our scheduling team will review your insurance and contact you to confirm the appointment. Please allow about one week for insurance verification, referrals, authorizations, and chart preparation.

Would you like to complete your patient forms now?

Completing your forms online may save time during check-in. You may also complete them at the office on the day of your appointment.

Yes, complete them online No, I will complete them at the office

Patient Questionnaire & Consent Forms

Review the information below — it's carried over from earlier steps. Correct anything that isn't accurate.

Additional questionnaire notes (medical/surgical/family/social history, allergies, current medications)

Consent Forms

Electronic Signature

Type full legal name *

Date *

If signing as a representative, relationship to patient

I confirm the above signature and information are accurate and I am authorized to sign.

Would you like to upload any medical information for our team to review before your appointment?

Yes No I will bring the records to the office

Review Your Appointment Request

Submitting your request and preparing your documents…

✓

Your Appointment Request Has Been Received

Thank you for choosing Machado Cardiology. Our team will review your request, verify your insurance, and contact you to confirm your appointment.

Your appointment is not final until it has been confirmed by our scheduling team.

How would you like to schedule?

Are you a new or returning patient?

When was your last visit with our practice?

Patient Information

Emergency Contact

Pharmacy

Primary Care Provider Information

Insurance Information

Insurance Card & Photo ID

Referral Review

Have you been admitted to a hospital or visited an emergency room within the last three months?

Would you like to upload any hospital documents?

What is the main reason for your appointment?

Cardiac Clearance Details (optional)

Select an Office Location

Select an Appointment Date and Time

Would you like to complete your patient forms now?

Patient Questionnaire & Consent Forms

Consent Forms

Electronic Signature

Would you like to upload any medical information for our team to review before your appointment?

Review Your Appointment Request

Your Appointment Request Has Been Received