Patient Forms

Thank you for choosing Orthopaedic Associates for your orthopaedic care. For your convenience, you may download, print, and complete our required patient forms below*. Please remember to bring your completed forms, along with the following pieces of information, to your scheduled appointment:

  • Insurance Card
  • Photo ID
  • Referrals (If required by your insurance)
  • Co-Payments (If required by your insurance)

*Please note, in order to autofill the forms, you will need to download them to your computer and access them through Adobe.

New Patient Forms

Please use the link provided to download and print our new patient forms.

New Patient Forms (PDF) Dr. Chipman New Patient Forms (PDF) Dr. Landry New Patient Forms (PDF)

Returning Patient Forms

Please use the links provided to download and print our returning patient forms.

Dr. Chipman Forms (PDF) Dr. Landry Forms (PDF) Demographic Sheet (PDF) Authorization to Release Medical Information (PDF) Medication Record (PDF) Patient Correspondence Authorization (PDF)

Authorization to Release Medical Records

Please use the link provided to download and print our Authorization to Release Medical Records form.

Authorization to Release Medical Records (PDF)

Affordable Care Act Letter

Please use the link provided to download and print our Affordable Care Act Letter.

Affordable Care Act Letter (PDF)

 

Orthopaedic Associates, P.A. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

The latest version of Adobe Acrobat Reader is required to view and print PDF files, and it is available here.

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