Patient Forms

Initial Visit

For your convenience, we use an online pre-registration tool. You will receive a link approximately 72 hours before your new patient appointment to complete your forms online. If you prefer not to do that, you will complete the forms live with a Slocum Orthopedics Registration Specialist. Below is a list of items and information to bring to your first appointment:

  •  Your insurance card.
  •  Previous records and X-rays sent from your referring physician or emergency room to us.
  •  Make sure you have 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.

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

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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.