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.
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.
New Back Patient Forms
(Dr. Carlson, Dr. McKenzie)
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.
New Back and Neck Patient Forms
(Dr. Alvine, Dr. Geisinger, Dr. Wingate)
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.
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.
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.
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.
Release of Health Information
Orthopedic Institute releases copies of patient records upon request provided we receive a valid authorization signed by the patient or legal representative.
HIPAA Notice of Privacy Practices
This notice describes how 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.
Financial Policy for Patients
Orthopedic Institute values our patients. In order to have a financially respectful relationship with our patients, we want all patients to be aware of our financial policy.
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.
