If you need assistance, please feel free to give me a call.
We are an out-of-network practice focused on delivering individualized, concierge-level orthopedic care.
Please take the time to fill out the relevant forms in the comfort of your own home or office. This will eliminate the need to fill out multiple sheets in our office, providing a hassle free visit to our clinics.
We strongly encourage you to use a computer to fill out the patient forms to avoid legibility issues and to allow us to easily search for your information in the future. Once filled out, you can save the file for your records and print one to bring it in at the time of your visit.
Filling out the forms correctly and completely prior to your office visit will give us the opportunity to provide you with the best possible care.
Important Notes about HIPPA: We are respectful and committed to your right to maintain the privacy of your medical information. If you would like to know the details of our Privacy Policy, you may review the document found in the chart below. If you have additional concerns or questions after reviewing this policy, please feel free to follow up with our staff. In order for our practice to release your medical records, you must fill out and sign the Medical Information Release form. This form must be updated from time to time.
If you cannot access the forms, please click on the icon to download the free Adobe Reader software.
| Clinic Forms | When To Use | Download | |
|---|---|---|---|
| New Patient Forms | |||
| New Patient Packet | Complete prior to first clinic visit | ||
| Established Patients Forms | |||
| Demographics/Insurance Update | If you moved or changed insurance carriers since last visit | ||
| HIPAA Forms | |||
| Plancher Orthopedics Privacy Policy | If you are interested in learning about the details of our privacy policy | ||
| Acknowledgement of Receipt of Notice of Privacy Practices | Confirm you have received and reviewed the Notice of Privacy Practices | ||
| Medical Records Release | If you would like to have your medical information released, you must complete and return this form. | ||
If you need assistance, please feel free to give me a call.
We are an out-of-network practice focused on delivering individualized, concierge-level orthopedic care.
