We’ve made the form process easy. Just click the ‘download now’ button to open a single PDF with all necessary forms enclosed. This self-contained PDF is interactive, so you can fill it out on your computer and then print it to bring with you to your appointment. Or, if you prefer, you can print it first and fill it out by hand.
If you are requesting The Orthopaedic Center to release your medical records to you or another treating physician please complete the following forms.
If you are a referring physician please complete the following form and submit to firstname.lastname@example.org.
Monday - Friday: 8:00AM to 5:00PM.
What to bring to your first appointment.
IF applicable please bring a list of:
- Prescription medications including dosages you are currently taking
- Surgical History
- Past Medical History
- MRI films and reports
- X-Ray films and reports
- Medical reports
- Emergency room records
- Photo identification (Driver License, State ID, Military ID, Passport)
- Primary Care Physician Information
- Insurance Card
- Social Security Number for insurance purposes
- Social Security Number AND Date of Birth of Primary Insurance Policy Holder
- Minors must be accompanied by a responsible party
Outside referrals for MRI, Physical Therapy or Osteoporosis/Dexa Scan should arrive 30 minutes before appointment for processing.
Our practice accepts most major insurance plans and contracts with the following companies. If we do not participate with your insurance and your plan allows out of network benefits, our office staff will assist you with the necessary paperwork so you can receive reimbursement directly from your insurance company.
If you do not see your insurance listed in the document, please call the office to speak with one of our knowledgeable staff members about your individual coverage.
Click on the image below to download our list of accepted insurances.
Click on image above to download Insurance List
We would like to take advantage of this opportunity to educate our patients about The Orthopaedic Center’s financial policies.
We offer CareCredit® for financing.