You have decided to make an appointment with an orthopedic specialist.
Some insurance companies require a referral before you schedule an appointment. Please check with your primary care physician or your insurance carrier.
What To Bring To Your Office Visit
These forms are to be completed and brought to your visit.
PLEASE FILL OUT, PRINT, AND BRING TO YOUR APPOINTMENT. To be completed by all new patients.
Authorization To Leave Personal Health Information By Alternative Means.
These forms are only to be completed if they fit the needs of the patient. They are not requried for all patients.
Authorization to release health care information to a third party.
Authorization to release health care information to a third party for child’s information.
As a general rule, we require the consent of a parent or legal guardian in order to provide health care services to a minor child (someone under the age of 18).
Authorization of Disclosure of Protected Health Information.