Holter Monitor (Ambulatory ECG)
Patient Information and Consent Form
What is a Holter Monitor?
A small, portable recorder that continuously tracks your heart's electrical activity (ECG) for 24 hours up to several days while you go about your normal day. No radiation. No needles. No sedation.
Why has my doctor referred me?
- • To investigate palpitations, irregular heartbeat, dizziness or fainting
- • To detect abnormal heart rhythms that a short ECG may miss
- • To monitor a known rhythm condition or check how treatment is working
What happens — Step by Step
Arrive & check in
You will be welcomed by our staff and taken to a private room to have the monitor fitted.
Skin prepared
A few areas of your chest will be cleaned, and a small amount of hair may be shaved so the electrodes stick well.
Electrodes & recorder attached
Small sticky electrodes are placed on your chest and connected to a small recorder worn on a belt or strap.
Keep a symptom diary
You will be asked to note your activities and any symptoms (e.g. palpitations, dizziness) and the time they occur.
Keep the device dry
Continue your normal daily activities, but do not shower, bathe or swim while wearing the monitor.
Return the monitor
At the end of the recording period, return the device to the clinic so the recording can be analysed.
After the test — no risks, no downtime
- • No recovery time needed — some people get mild skin irritation from the adhesive
- • A specialist will review your recording and send a report to your doctor within 7 working days
- • Your health information is kept private under Australian privacy law
Privacy Notice
Collection purpose: Your personal and health information is collected by HeartWise Cardiology solely for the purpose of performing and reporting this Holter monitor recording and providing you with specialist cardiology care.
Storage & security: Your information is stored securely in our clinical records system, accessible only to authorised staff and treating clinicians, and retained in accordance with Western Australian health records legislation.
Disclosure: Results and relevant clinical information will be reported to your referring doctor and any other clinician directly involved in your care. Information will not be disclosed for other purposes without your consent, except as required by law.
Sensitive health information: This information is sensitive personal information under the Privacy Act 1988 (Cth) and the Australian Privacy Principles (APPs).
⚠️ Urgent care limitation: This form is for administrative consent purposes only. If you are experiencing chest pain, breathlessness, or any medical emergency, call 000 immediately.
For our full Privacy Policy or to access/correct your information, contact us at info@heartwisecardiology.com.au or (08) 6102 1655.
📋 Device Responsibility & Replacement Cost
I understand that the Holter monitor is a specialised medical device with a replacement value of approximately AUD $2,000.
By signing this consent form, I acknowledge that I am responsible for taking reasonable care of the device while it is in my possession and for returning it to HeartWise Cardiology by the agreed date and time.
I understand that if the device is lost, stolen, or damaged beyond normal wear and tear while in my care, I may be liable for the full replacement cost of AUD $2,000.
📋 By signing below, I confirm that I understand and agree to the following:
I understand the nature and diagnostic purpose of the Holter monitor recording.
I have had the opportunity to ask questions and am satisfied with the answers provided.
I agree to keep the device dry and to return it to the clinic at the end of the recording period.
I acknowledge that I am responsible for the care and safe return of the Holter monitor device, and that I may be liable for the replacement cost of AUD $2,000 if the device is lost, stolen, or damaged beyond normal wear and tear.
I consent to my personal and health information being collected, stored, and used by HeartWise Cardiology as described in the Privacy Notice above.
I consent to my results being shared with healthcare professionals involved in my care, in accordance with Australian privacy and confidentiality laws.
Sign here with your finger or mouse
By signing above, I confirm the information provided is accurate and I consent to its use for my healthcare.
Perth CBD • Nedlands • Riverton • Joondalup
T: 08 6102 1655 | F: 08 6118 5522 | E: admin@heartwisecardiology.com.au | W: heartwisecardiology.com.au