Forms for Patients
To save you time, Northtowns Orthopedics has provided our basic office forms in a printable format for you to complete prior to your arrival. These brief instructions are designed to assist you.
To view the electronic version of these forms, Adobe Acrobat Reader is required on your computer. To view the forms with Acrobat Reader, simply click on the name of the form you wish to view. Once the form is opened, you can print it and complete it at home.
To obtain Adobe Reader for free, click below:
1) All new patients must complete the following forms:
- Patient Information
- Medical History – 2 pages
· Shoulder History Form
· Hand, Wrist and Elbow History Form
· Knee History Form
· Foot History Form
- Patients of Dr. Lanighan only – Medical History and Patient Information Form – 4 pages
- Payment Authorization
2) If your visit is a result of a motor vehicle accident, you must complete the following form:
3) If your visit is a result of a work injury or illness, you must complete the following form:
Additionally, there will be one or two short forms for you to complete at the time of your visit, including:
- HIPAA Notice (Patient Privacy Statement) – 2 pages
These forms are also available at the time of your arrival at our office.
We thank you for allowing us to serve your orthopedic needs.
If you need assistance, do not hesitate to contact our office during normal business hours at 716-636-1470.