I am happy to be a part of a department that provides such comprehensive diagnostic and interventional radiology services. We strive to provide the latest techniques and technologies to our patients.
High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack, and stroke. And since high cholesterol has no symptoms, the only way to know your cholesterol levels is by having them checked.
Register for your Comprehensive Cholesterol Screening by filling out the form below. Cholesterol Screenings are avaialble for $30 ($40 for nonmembers) at The Wellness Center. Included in the screening are Total Cholesterol, HDL, LDL, TC/HDL ratio, Triglycerides, Glucose, and Blood Pressure.
Please complete the following information. This will enable us to promptly process the official birth certificate after you deliver your baby
If yes, please specify Mexican, Puerto Rican, Cuban, etc.
We understand that busy days with work and kids can make you forget about that appointment you have been meaning to schedule. Therefore, we have designed the online appointment request form for you to fill out. Call (504) 885-4223 or send an appointment request using our secure form and someone from our patient access department will respond promptly to your request. Patients needing an x-ray or lab performed at East Jefferson Imaging Center can walk in without an appointment.
Disclaimer: This is not an official signed physician order. A signed physician order is required before your appointment arrival. This is meant as a request. Following a phone call from patient access, your official date and time will be confirmed.
You will be prompted to attach a copy of your ID and a copy of both the front and back side of your insurance card. Before beginning this pre-registration form, you may wish to have these scanned to a file on your computer, ready to upload. As an option, you may also fax to: (504) 503-5485; scan and email to: email@example.com or if you would prefer, we will be happy to make these copies for you. Feel free to visit our Woman & Newborn area located on the 4th floor of the hospital.
Please send a copy of your ID and a copy of both the front and back side of your insurance card. Fax to: (504) 456-5485; scan and email to: firstname.lastname@example.org or if you would prefer, we will be happy to make these copies for you. Feel free to visit our Woman & Child area located on the 4th floor of the hospital.
Lifetime membership fee of $50 for first qualifying member, $25 for second member in the same household.
Notice of Privacy Practices: East Jefferson General Hospital offers assistance to its Healthy Lifestyles members with processing their East Jefferson General Hospital bills. Staff members are EJGH employees and serve in an adjunct capacity to the hospital's patient finance department. If you use the billing assistance service, Healthy Lifestyles staff will have access to your medical billing records contained in the EJGH records systems. Federal privacy laws will prevent Healthy Lifestyles from assisting you with processing your bills with any other healthcare organization. EJGH Healthy Lifestyles maintains a general membership listing. This listing does not contain any medical information on members. The list is used solely for administration of the Healthy Lifestyles program and is not used or disclosed for any other purposes.
East Jefferson General Hospital reserves the right to alter or discontinue this program. Members must be 21 years of age.
Please Note: Submitting this form does not finalize membership. Payment is due prior to becoming a member. Please call the Healthy Lifestyles Ofice at (504) 503-4066 to arrange for payment.
at East Jefferson General Hospital
It is my understanding that the above named patient would like to participate in the Integrative Medicine Program at EJGH. An Integrative Medicine evaluation with an EJGH Nurse Practitioner is highly recommended before beginning any activity.
Integrative Medicine Program • 3726 Houma Blvd., Metairie LA 70006 • phone: 504-503-6000 • fax: 504-503-6800 • email: email@example.com
Please answer each question below. Your responses will help the dietitian better understand your nutritional goals and needs.
(*) Required Fields
Please check to be sure you have answered all questions. Thank you very much!
Check all that apply.
Please indicate the days and times you are usually available to volunteer. Shifts include morning (8-12n), afternoon (12n-4p) and evening (4-8p). Flexible hours are available.
In the event of an emergency whom should we notify?
Please list your current or most recent employer, if applicable.
I understand and agree that submitting this application form does not automatically register me as a East Jefferson General Hospital volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering, including but not limited to a minimum committment of 50 hours of service.