Plancher Orthopaedics & Sports Medicine, PLLC  
Your Complete Orthopaedic Care Facility.
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Plancher Orthopaedics & Sports Medicine, PLLC

Patient Information - Patient Forms

Please take the time to fill out the relevant forms in the comfort of your own home or office. This will eliminate the need to fill out multiple sheets in our office, providing a hassle free visit to our clinics.

We strongly encourage you to use a computer to fill out the patient forms to avoid legibility issues and allow us to easily search for your information in the future. Once filled out, you can save the file for your records and print one to bring it in at the time of your visit.

Filling out the forms correctly and completely prior to your office visit will give us the opportunity to provide you with the best possible care.

If you cannot access the forms, please click on the icon to download the free Adobe Reader software.

Download Acrobat

Important Notes about HIPPA: We are respectful and committed to your right to maintain the privacy of your medical information. If you would like to know the details of our Privacy Policy, you may review the document found in the chart below. If you have additional concerns or questions after reviewing this policy, please feel free to follow up with our staff. In order for our practice to release your medical records, you must fill out and sign the Medical Information Release form. This form must be updated from time to time.

Type of Form   When To Use   Download
New Patient Forms        
New Patient Packet   Complete prior to first clinic visit   Pdf
Established Patients Forms        
New Problem Information   New injury for returning patient   Pdf
Demographics/Insurance Update   If you moved or changed insurance carriers since last visit   Pdf
HIPAA Forms        
Plancher Orthopaedics & Sports Medicine Privacy Policy   If you are interested in learning about the details of our privacy policy   Pdf
Acknowledgement of Receipt of Notice of Privacy Practices   Confirm you have received and reviewed the Notice of Privacy Practices   Pdf
Medical Release   If you would like to have your medical information released, you must complete and return this form.   Pdf