Patient Forms

patien6The following forms may be printed and completed prior to your visit to University Orthopedics. Please complete those applicable to your appointment to the best of your ability. If you have any questions about the forms, or are unable to print a copy, please call 423.267.4585 and ask to speak to an Appointment Scheduler.

All patients must complete an Information Sheet or update an existing record if a returning patient. Also, a Patient History Form must be completed by all patients for each visit.

Patient Information Sheet

Authorization for Release of Information Form

New Patient Consent for The Use and Disclosure of Health Information for Treatment, Payment & Healthcare Operations

Patient Request for Confidential Disclosure of Protected Healthcare Information

NOTE: Please do not FAX these forms to the office. Bring them with you at the time of your visit unless you have been instructed otherwise by a University Orthopedic representative.