Patient Forms

Once you have made your initial appointment, you may pre-register online by completing the interactive forms below, or you may download and print the forms, fill them out and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the new patient registration process.

New Patients

Click here to visit the New Patients section of our website for more information about your first visit and forms to complete

Interactive Forms:

• New Patient Registration*
• Medical History*

Downloadable Forms:

• New Patient Registration *
• Medical History *
• Spine History **
• Patient Financial Policy *
• Consent to Treat/Consent to Disclosure of Health Information/Assignment of Benefits/Patient Financial Responsibility *
• Notice of Privacy Practices *

Returning Patients

Click here to visit the Returning Patients section of our website for more information about subsequent visits.

Downloadable Forms:

• Spine History **
• Medical History Update
• Patient Financial Policy *
• Consent to Treat/Consent to Disclosure of Health Information/Assignment of Benefits/Patient Financial Responsibility *
• Notice of Privacy Practices *
• Patient Survey Form

* All new patients must complete each of these forms. For the New Patient Registration and Medical History forms, you can complete them online OR download them and bring them to our office. You do NOT have to do both.

** New patients with a spine disorder (neck or back) also need to complete this form.

Medical Records

In order to release your records we will need a completed and signed Authorization for Release of Health Information. The form may be downloaded by clicking on the link below. Please note that there is nominal copying fee of 35 cents per page plus postage to send the records to the patient.

Authorization for release of your Falmouth Orthopaedic Center records

Disability/FMLA Forms

Disability and FMLA forms and a signed authorization may be dropped off, mailed, or faxed (207-781-4426) to our office. The fee to complete each form is $15.00 which must be paid prior to form completion. Please allow 5 to 7 business days to complete the form.

Disability FMLA Form Policy

Please note: It may take a few minutes to load the forms if you are using a dial-up Internet Connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.