Once you have been diagnosed with heart failure and your doctors determine that you may be a candidate for heart transplant, you can ask your physician for a referral to our program. Our team will evaluate your case to determine if transplant is right for you.

Patient's Medical History

Please download the Patient’s Medical History form and bring it with you to your first appointment.

To complete the referral process you will need to provide us with:

  • Your most recent history and physical report 
  • Your most recent lab work 
  • Any radiology reports 
  • Reports of any surgery or procedures you have had (for example colonoscopy, pap smear, mammogram, abdominal surgery, etc.) 
  • Immunization records 
  • Documentation of any psychiatric history
  • Reports of any dental work you may have had 
  • Proof of medical insurance

After we receive all your information, our team will review the information. If you're found to be an appropriate candidate for transplant, you will be scheduled for a clinic appointment.