Your visit to The Orthopedic Center will be most effective if you plan ahead.
It is essential to give your doctor the information he or she needs to provide the best care possible.
Our Medical History forms will help you and your doctor discuss the issues that are key to your treatment.Before your visit, we will point out the forms we would like you to fill out.
Forms
Form 1 – Patient History Sheet
Form 2 – Patient History Sheet
Form 3 – Pain Assessment (Low Back)
Form 4 – Cervical Disability
Form 5 – KOOS (Knee)
Form 6 – HOOS (Hip)
Form 7 – DASH (Arm/Hand/Shoulder)
Form 8 – Foot & Ankle
Form 9 – DHI (Dizziness)
Welcome Letter – Easton New Patients
Welcome Letter – PT New Patients
Financial Obligation Forms
Physical Therapy No Show Form
Medical Records Release Authorization
Patient HIPAA Release Authorization
X-ray Release Authorization