Skip to main content
Home
Services
Physicians
Patients
Forms
Cardiology Consultation
Echocardiography
Stress Echocardiography
Exercise Stress Test
Holter ECG Monitoring
Cardiac Loop Monitoring
ABI Testing
About Us
FAQs
Main Line:
(306)-757-2478
Fax:
306-585-3993
Home
Services
Physicians
Patients
Forms
Cardiology Consultation
Echocardiography
Stress Echocardiography
Exercise Stress Test
Holter ECG Monitoring
Cardiac Loop Monitoring
ABI Testing
About Us
FAQs
Request for Holter ECG Monitoring
Only Health -Care Providers (Medical Doctors & Nurse Practitioners) May Submit a Request!
Request for Holter ECG Monitoring
First Name
*
Last Name
*
Sex
*
Male
Female
P.H.N
*
Patient Health Number
Phone
*
Date of Birth
*
Select year, month, day
Email
Address
Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Diagnosis / Clinical History
*
Palpitations
Dizziness/light-headedness
Arrhythmia detection
Stroke/ TIA
Syncope/ Fainting
Paroxysmal atrial fibrillation
Permanent atrial fib/flutter (assess rate-control)
Assess response to antiarrhythmic therapy/ablation procedure
Chest pain/ Atypical angina
Chest pain/ Atypical angina
Dyspnea
Pacemaker assessment
Cardiomyopathy
Screening for autonomic dysfunction
Study Duration
24 hours
48 hours
72 hours
Notes
Ref. MD
Copy to
Date
Select year, month, day
Study Date
Select year, month, day
reCAPTCHA
If you are human, leave this field blank.
Submit
Δ