Book Arrhythmology consultation

The original PDF has no box for the First name: there is only the dotted line. Write first and last name together in the field Last name, or add the first name by hand on the printed form.

In the original PDF the examinations below — TTE, cycle ergometry, Schellong test, provocation tests, 24-hour Holter ECG, R-test, VitalPatch, microbubble TTE, transoesophageal echo — are not real checkboxes: they are drawn squares. They cannot be ticked from here. Write the ones you need in the field Other.