Cardiologist Authorization and Health Inventory Form

Your patient is applying to attend Upbeat Hearts Camp, a specialized cardiac camp for children with heart conditions.

Your cooperation is requested to provide our medical staff and medical care providers with pertinent medical history regarding your patient.

The camp is scheduled for July 27 – 31, 2025.


The last clinic visit must be within 1 year of the application. In addition, a copy of the last clinic note is required.