Patient Forms
PREPARING FOR YOUR FIRST VISIT?
For your convenience, new patient forms are available for download on your physician’s full profile page, which can be found by selecting your physician from the Physician Finder. Once downloaded, please print, complete and bring with you to your appointment.
MEDICAL RECORD RELEASE FORM
If requesting release of your medical records, please click here to download the request form. You are welcome to return the completed form in-person, by fax or mail to your physician’s office. You can find your physician’s office information on his/her bio page from the Physician Finder.
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. Click here to download.
MRI SCREENING FORM
If referred for an MRI scan, Orthopedic ONE Imaging Services offers you the latest and most advanced imaging equipment in a modern and comfortable environment.
Click here to download our MRI Screening Form, which will allow our team to collect information vital to providing you with the best care and give important instructions to ensure that you enter the MR environment safely.
ADVANCE DIRECTIVES FORMS
Click here for printable State of Ohio Advance Directives
HELPING YOUR MEDICAL PROFESSIONALS STAY INFORMED WITH INTEROPERABILITY PARTICIPATION
Today your medical needs are spread out over a wide network of health providers – family physicians, specialists, hospitals and clinics. Keeping each provider up to date with changing health conditions and medications can be a daunting task. CliniSync Health Information Exchange and Medent Community Chart were developed to help your medical providers connect, improving coordination of your care.
Click here to read more about Orthopedic ONE’s participation in The CliniSync Health Information Exchange
Click here to download a copy of the Request to Change Consent form