Patient Forms

Initial Visit

Once you have made an appointment with Slocum Center for Orthopedics & Sports Medicine, you will need to fill out our patient forms. To make it more convenient for you, you may download our required patient forms, print them, and fill them out prior to your appointment. 

Here's what you'll need to bring to your first appointment. We've also included some things you should tell us before you arrive.

• Bring your insurance card.
• Have previous records and X-rays sent from your referring physician or emergency room to us.
• Make sure you arranged for a referral from your primary care physician if such a referral is required by your insurance.
• Let us know if you have a disability and need accommodation.
• Let us know if you need an interpreter for your visit so we can make those arrangements.
• We take your photo to ensure your privacy, so we make certain that we recognize you.
• Feel free to discuss any questions, including those about fees. 
• Slocum Center offers an array of financing options, including a sliding scale to help make our services more affordable.

Please note: You will need Adobe Acrobat Reader to view the following patient forms. 

Download Adobe Reader

Before Your First Visit

Patient Registration (pdf)
Orthopedic History (pdf)

Medical Records

Authorization to Communicate (pdf)
Authorization to Communicate - Spanish (pdf)
Authorization to Release Medical Records (Released to Slocum) (pdf)
Authorization to Release Medical Records (Released from Slocum) (pdf)
Notice of Privacy Practice (pdf)
Medical Records Amendment (pdf)
Request for Restriction (pdf)

Slocum Surgery Center

Patient Rights and Responsibilities (pdf)

Slocum Center for Orthopedics & Sports Medicine complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.