New Patient Forms

Thank you for choosing Lake Cook Orthopedic Associates for your orthopedic care. These forms should be completed in full and signed in all indicated areas. Completing all forms fully prior to your visit will streamline your initial time in the office before seeing the doctor.

Please bring all completed forms to your first visit along with your current insurance card. If you have x-ray studies, lab results or other medical records that have previously been obtained regarding your current problem, please have them with you at the time of your visit. If your primary care doctor has this information, please obtain it prior to your visit.

For those patients insured in a program that requires a referral for specialty care, you must have the referral form with you at the time of your visit. This is a requirement of the insurance carrier, and if the form is not available, it may result in the necessity to reschedule your appointment.

If the new patient is a minor, a parent or guardian must be with them at the time of evaluation. If a friend or relative presents with the underage patient, they must have a signed letter authorizing treatment by Lake Cook Orthopedic Associates for the specific date of the appointment.

Patients who cannot speak or understand English should be accompanied by a person that can provide interpretation in their native language. These services are not available on site at Lake Cook Orthopedic Associates.

Print All New Patient Forms Review of Systems Form Patient History Form Notice of Privacy Practices Form Financial Policy Patient Medical Form Durable Medical Equipment Policy Patient Information Authorization

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