FORMS FOR YOUR APPOINTMENT
Take a moment to view our Notice of Privacy Practices.
Please download and print required forms and fill in with blue or black ink.
- Patient Information Sheet
- Patient Medical/Social History
- Patient-Priviacy-Practices-form
- Bureau of Workers’ Compensation Questionnaire
- Liability Injuries Questionnaire
- MRI Screening Form
Insurance:
- Please contact your insurance company prior to scheduling your appointment to ensure that Far Oaks Orthopedists is participationg in the plan.
- So that we can bill your insurance company accurately and in a timely manner, please bring the following with you to your appointment:
- Insurance card(s)
- 2. Subscriber name and date of birth
- 3. Order in which to bill the insurance (Who is Primary? Seconday?)
- Your copay will be collected when you check out.
We are not participating in the following plans (only a partial list):
Caresource, Molina, Amerigroup, Cigna