Location Shukla Cardiac Center40 Elm Street, Unit 282Sudbury, ON, P3C 1S8 Contact Phone #: (705) 523-7252Fax #: (705) 523-7262 Patient Intake Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Patient Full Name *FirstLastAddress: *City: *Province: *Postal Code: *Cell. Phone: *Alt. Phone:Date of Birth: *Gender: *Health Card #: *Height (cm): *Weight (kg): *Clinical Information/Indications: *Request For Diagnostic Test *Chest PainLV FunctionArrhythmiasValvular Heart DiseaseCheckboxesEchoStressECGHolterUrgency *UrgentConsultReferred By: *Date: *Submit