GirardOrtho.com


New Patient Packet
Please click on the links below to open the forms that need to be completed for your first visit with our practice.

Please arrive 15 minutes prior to your initial appointment and bring your valid insurance card or HMO authorization notice. If you've had recent diagnostic studies taken elsewhere such as X-rays or MRI services, it is necessary that you bring them to your appointment. Also, if you have any written reports from physicians outside of our medical group, please bring them to your appointment.



?Please click on the link below in order to register, log in and complete the Medical History Questionnaire:
https://www.exscribepatientportal.com/Girard/


The following forms can either be filled out online (use your "tab" key on your keyboard to move from field to field and type in the information) and then print them out, or you may just print them out and fill in the information by hand. Some forms you will have to physically sign your signature to once you have printed out the completed form.

GOS WEB Patient Registration Form.doc
GOS WEB Use and Disclosure Consent Form.doc

GOS WEB ENR Worker's Comp Info Sheet.doc
(For Dr. Rickards'  worker's comp patients only)

The forms listed below are only printable and you must sign and date the forms.
GOS Financial Policy.doc
GOS Receipt of Notice of Privacy.doc

The forms listed below are only printable and for you to keep, not return.
GOS Additional Services Info.doc
GOS Notice of Privacy.doc
GOS Arbitration Agreement Letter.doc

Please be sure to bring the completed forms with you on your first appointment.

Patient Survey
Please fill out the patient survey so that we know how we are doing.
GOS WEB Patient Survey.doc.

 

 

 

 

 

 

 

 

 

 

 

 




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