All new patients and established patients who have not been seen in the last twelve (12) months are required to update the patient forms below. If you have an upcoming appointment, you may complete the following forms and bring them with you to your appointment.
- Patient Registration Forms (2 pages)
- Patient Medical History
- Patient Medication List
- Quick Dash Form – Dr. Khan’s patients and all hand therapy patients
- HIPAA Privacy Practices
- Patient Financial Policy
- Notice of Privacy Practices Acknowledgement
Please Note: To fill out these PDF forms on your computer, please download the latest free Adobe Acrobat Reader application.
Patients should also bring the following:
- Referral forms as required by your health insurance plan. It is your responsibility to ensure you understand and have complied with your insurance provider’s policies. If you do not have your referral at the time of your appointment you will either (1) be responsible for services provided; or (2) be required to reschedule your appointment until such time as you have proper authorization as required by your policy.
- Current insurance cards will speed up payment of your claim. Updated cards may contain important changes that affect your coverage. We will also ask for a photo ID such as your driver’s license.
- Resources to pay for co-payments and for other services not covered by your insurance. We accept cash, check, and Discover, MasterCard and VISA.
- Uninsured patients should be prepared to pay for their initial office visit. Please call our office in advance of your appointment to determine the amount that will be due.
- Copies or originals of previous X-rays and reports will save you money and prevent unnecessary radiation exposure.
- Please bring along any orthotics, braces, or walking aids you routinely use.
Additional forms:
- Authorization to Release Healthcare Information Form
- Workers’ Comp Form
- Credit Card Authorization Form
Please Note: To fill out these PDF forms on your computer, please download the latest free Adobe Acrobat Reader application.