Tri-State Orthopaedics & Orthopaedic Urgent Care

225 Crosslake Dr.  Evansville, IN 

Main Office: (812) 477-1558

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Patient Medical Forms

Forms
Provided below are various forms that require completion prior to your visit and/or surgery. Please download the appropriate form as directed by your physician and/or staff by clicking on the name of the form. If you can not access the form, please click on the Adobe box. This will allow you to download this software, providing access to the forms. Please bring the completed form/s with you to your scheduled visit. This will help expedite the registration process. Thank you.

Our Responsibilities
We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice and notify you if we cannot agree to a requested restriction. 

General Pain Form • Download PDF 
Workers Compensation • Download PDF

Workers Compensation Return to Work • Download PDF

Dr. Ante Pain Form • Download PDF  
Dr. McFadden Pain Form • Download PDF 
Back Pain Form • Download PDF 
Scoliosis History Form  • Download PDF

Hand Problem Form Download PDF

Medical Release Form Download PDF

 

If you can not access the forms you can click on the icon to download the software.

 

 

 

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Copyright © 2005 Tri-State Orthopaedic Surgeons, Inc.                           

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