Patient Forms

Printable patient forms are available in PDF format, which can be viewed, navigated, and printed from a workstation using the freely available Acrobat Reader software from Adobe Systems Inc. Not all patient forms are available for download.

Medical Records Request Forms

  •  For Electronic Access To Your Records, please complete the following five forms.
  1. Patient Request for Medical Records Release
  2. Patient Records Information
  3. HealthPort Instructions for Electronic Records
  4. HealthPort Patient Request Form for Electronic Records
  5. HealthPort E-Delivery Response Example
  • For Non-Electronic Access To Your Records, please complete two following forms.
  1. Patient Request for Medical Records Release
  2. Patient Records Information

Miscellaneous Forms

Christopher E. Baker, M.D.  Sports Medicine / Knee / Shoulder & Elbow

Steven A. Barna, M.D. Interventional Spine / Regenerative Medicine

Thomas L. Bernasek, M.D. — Adult Reconstruction & Arthritis Surgery / Hip / Knee

Dr. Bernasek's forms cannot be downloaded from our Web site and will be distributed upon your arrival for your appointment.

James B. Billys, M.D. — Spine Surgery

Michael P. Clare, M.D. — Foot & Ankle Surgery

Thomas M. Davison, M.D. — General Orthopedic Surgery

Please contact Florida Orthopaedic Institute prior to printing and filling out forms to verify which forms are required for your appointment.

Eddy L. Echols, Jr., M.D. — General Orthopedics / Shoulder & Elbow Surgery / Regenerative Medicine / Sports Medicine

Mark A. Frankle, M.D. — Shoulder & Elbow Surgery

Michael J. Garcia, M.D. — Hand & Wrist Surgery

Grant G. Garlick, M.D. — Adult Reconstruction & Arthritis Surgery / Sports Medicine / Knee / Regenerative Medicine

Seth I. Gasser, M.D. — Sports Medicine / Knee / Shoulder & Elbow

Dr. Gasser's forms cannot be downloaded from our Web site and will be distributed upon your arrival for your appointment.

Kenneth A. Gustke, M.D. — Adult Reconstruction & Arthritis Surgery / Hip / Knee

Please contact Florida Orthopaedic Institute prior to printing and filling out forms to verify which forms are required for your appointment.

Dolfi Herscovici, Jr., D.O. — Foot & Ankle Surgery / Orthopedic Trauma

Alfred V. Hess, M.D. — Hand & Wrist Surgery / Regenerative Medicine 

Anthony F. Infante, Jr., D.O. — General Orthopedic Surgery / Orthopedic Trauma / Hip / Knee

Please contact Florida Orthopaedic Institute prior to printing and filling out forms to verify which forms are required for your appointment.

Howard B. Jackson, M.D. — Interventional Medicine

Steven T. Lyons, M.D. — Adult Reconstruction & Arthritis Surgery / Arthritis Surgery / Hip / Knee / Regenerative Medicine

Mark A. Mighell, M.D. — Shoulder & Elbow Surgery

Michael A. Miranda, D.O. — Adult Reconstruction & Arthritis Surgery / Hip / Knee

Brian Palumbo, M.D. — Adult Reconstruction & Arthritis Surgery / Hip / Knee

Ioannis P. Pappou, M.D., PhD. — Hand & Wrist Surgery / Shoulder & Elbow Surgery

John D. Ramirez, D.C. Chiropractic Services

Please contact Florida Orthopaedic Institute prior to your appointment.

David A. Reina, D.C. — Chiropractic Services

Dr. Reina's forms cannot be downloaded from our Web site. You may either complete the forms online via our Patient Portal, or the forms will be distributed upon your arrival for your appointment.

Roy W. Sanders, M.D. — Foot & Ankle Surgery / Orthopedic Trauma / Regenerative Medicine

Jeff Sellman, M.D. — Primary Care Sports Medicine

Anjan R. Shah, M.D. — Orthopaedic Trauma

John M. Small, M.D. — Spine Surgery

Jeffrey D. Stone, M.D. — Hand & Wrist Surgery / Regenerative Medicine

Dr. Stone's forms cannot be downloaded from our Web site. They will be distributed upon your arrival for your appointment.

Arthur K. Walling, M.D. — Foot & Ankle Surgery / Musculoskeletal Oncology

David T. Watson, M.D. — Adult Reconstruction & Arthritis Surgery / Orthopedic Trauma / Hip / Knee

Marc A. Weinstein, M.D. — Spine Surgery

Every patient is required to complete one or two of the forms listed below. If you are unsure of which forms to print and complete, please contact Florida Orthopaedic Institute's scheduling department for further instructions at (813) 978-9797.