Patient Forms

To expedite your appointment, please download and complete all the applicable registration forms listed below.

You may EMAIL your forms prior to your appointment to:         

                              appointments@handwristcenter.com 

You may also bring your forms with you on the day of your appointment, but know that this may add to your total visit time.

You may also complete forms at our Center. For this option, please arrive an additional 30-45 minutes prior to your appointment.

Form instructions (please read the following to determine which forms apply to you):

  • All patients: Complete the forms: “Patient Registration Form;” “Medical History Form;” “Notice of General Disclaimer Form,” and the “Release of Information Authorization Form.”
  • Medicare patients: Complete the “Medicare (and Medi-gap) Acknowledgment Form” (in addition to the first 4 forms).
  • Patients with two or more insurance plans: Complete the “Additional Insurance Form” (in addition to the first 4 forms).
  • Minors (age 17 and under): All patients under the age of 18 must be accompanied by a parent (or another legal guardian) for their initial consultation. Following the initial consultation, a minor patient can be seen and treated without a parent (or another legal guardian) present only if the “Consent to Consult and Treat Minor Form” is completed. In addition to completing this form, please see our staff for additional details.

Forms:

 

HIPAA Policies and Procedures – Notice of Privacy Practices (For all patients; please read and print a copy for your records).

 

In addition to your registration forms, please email (or bring with you):

  • a government-issued photo identification card (we require everyone to be properly identified)
  • all insurance cards – if you are insured (original cards; no paper copies),
  • all pertinent medical records (including x-rays and test results) from other providers, and
  • a form of payment (we accept cash and credit cards: Visa, MasterCard, and Discover; no personal checks accepted on the initial visit).
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