Patient Forms

New Patient Forms

If you are a new patient to Orthopedic Institute, please download, print and complete the following forms and bring with you to your appointment. Download PDF

New Medicare Patient Forms

If you are a new medicare patient to Orthopedic Institute, please download, print and complete the following forms and bring with you to your appointment. Download PDF

New Back Patient Forms

If you are a new back patient to Orthopedic Institute, please download, print and complete the following forms and bring with you to your appointment Download PDF

New Hand Patient Forms

If you are a new hand patient to Orthopedic Institute, please download, print and complete the following forms and bring with you to your appointment. Download PDF

Authorization to Discuss Treatment

If you would like Orthopedic Institute to discuss your treatment with a third party, please complete the following form and bring it with you to your appointment. Download PDF

Consent for Treatment of a Minor

College students, athletes and other minors who come in for treatment without their parent/legal guardian need to have a permission form signed by their parent/legal guardian in order for us to provide treatment. Download PDF

Release of Records

Orthopedic Institute releases copies of patient records upon request provided we receive a valid authorization signed by the patient or legal representative. Download PDF

Notice of Privacy Practices

This notice describes now medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully and retain a copy for your records. Download PDF

Statement of Non-Discrimination and Languages

Orthopedic Institute complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Download PDF