Patient Forms
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Patient Forms that need to be filled out for Appointments
Please make sure you complete steps 1, 2 and 3

1. Patient Registration (Demographics and Insurance Information)
IMPORTANT - After you fill out this form, please print it out and bring it into the office.

2. EMR Link (Patient Health History)
This should take you 20 minutes to complete. This information will automatically be sent to our system once submitted so you do not need to print it out.

3. Privacy Notice (HIPPA Information)
Read, Print optional

 

 

Patient Checklist for an Office Visit

1. Patients having an examination of the Hips or Knees, please bring or wear shorts (without metal) for X-rays and examination. For shoulder and back examinations, please wear a tank top under shirt.

2. If you have had an X-ray or MRI, please bring the CD or films. This is very important!!! X-rays taken at Alexian Brothers, St. Alexius, Sherman, or Northwest Community can be viewed online, but studies taken elsewhere need to be brought in at time of appointment in order to prevent rescheduling of appointments.

3. Photo identification

4. Insurance Card

5. Co Payment

6. Any patient less than 18 years of age must bring an adult who is older than 18 years of age and is either a legal guardian or a letter by the legal guardian authorizing treatment and also a copy of the parent's driver license.