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 forms are available for download.
Patient Records Telephone Numbers
- Paper Records and/or Radiographic imaging requests (X-Ray, MRI, or CT scan): (813) 978-9700, ext. 7136
- Patient Records Department main phone number (for other inquiries): (813) 978-9700, ext. 7060
- Patient Records Department Fax Number: (813) 558-6001
Medical Records Request Forms
For Access To Your Records, please download and complete the following form.
Miscellaneous Forms
- Consent to Treatment and Care of Minors
- Disability Forms
- Lifetime Signature Authorization
- Notice of Patient Information Privacy Practices
- Urgent Care Registration Form
Sheyan J. Armaghani, M.D. — Spine Surgery
Dr. Armaghani’s forms cannot be downloaded from our Web site and will be distributed upon your arrival for your appointment.
Christopher E. Baker, M.D. — Sports Medicine / Knee / Shoulder & Elbow
Steven A. Barna, M.D. — Interventional Spine / Regenerative Medicine
Dr. Barna’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.
Ellen Beatty, M.D. — Hand & Wrist Surgery
Thomas L. Bernasek, M.D. — Adult Reconstruction & Arthritis Surgery / Hip / Knee
Dr. Bernasek’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.
Michael P. Clare, M.D. — Foot & Ankle Surgery
Eddy L. Echols, Jr., M.D. — General Orthopedics / Shoulder & Elbow Surgery / Regenerative Medicine / Sports Medicine
Timothy C. Epting, D.O — Foot & Ankle Surgery
Mark A. Frankle, M.D. — Shoulder & Elbow Surgery
New Patient paperwork cannot be downloaded from our Web site. The following forms are for follow up patients only.
Michael J. Garcia, M.D. — Hand & Wrist Surgery
Grant G. Garlick, M.D. — Adult Reconstruction & Arthritis Surgery / Sports Medicine / Knee / Regenerative Medicine
Dr. Garlick’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.
Seth I. Gasser, M.D. — Sports Medicine / Knee / Shoulder & Elbow
Dr. Gasser’s existing patients may download their form from this site. All other forms cannot be downloaded from our Web site and will be distributed upon your arrival for your appointment.
Christopher W. Grayson, M.D. — Adult Reconstruction & Arthritis Surgery
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
Benjamin J. Lindbloom, M.D. — Shoulder & Elbow Surgery
Steven T. Lyons, M.D. — Adult Reconstruction & Arthritis Surgery / Arthritis Surgery / Hip / Knee / Regenerative Medicine
Benjamin J. Maxson, D.O. — General Orthopaedics / Orthopaedic Trauma
Mark A. Mighell, M.D. — Shoulder & Elbow Surgery
- Dr. Mighell’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.
Hassan R. Mir, M.D., MBA, FACS — Orthopaedic Trauma
Michael A. Miranda, D.O. — Adult Reconstruction & Arthritis Surgery / Hip / Knee
Jason A. Nydick, D.O. — Hand & Wrist Surgery / Shoulder & Elbow Surgery
Brian Palumbo, M.D. — Adult Reconstruction & Arthritis Surgery / Hip / Knee
Dr. Palumbo’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.
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.
Donna A. Saatman, M.D. — Spine Surgery
Dr. Saatman’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.
Adil A. Samad, M.D. — Spine Surgery
Dr. Samad’s forms cannot be downloaded from our Web site. They 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
Dr. Small’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.
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.
Steven J. Tresser, M.D. — Spine Surgery
Dr. Tresser’s forms cannot be downloaded from our Web site and 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
Dr. Weinstein’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.
Seung Jin Yi, M.D. — Hip / Knee / Shoulder & Elbow Surgery / Sports Medicine
Dr. Yi’s forms cannot be downloaded from our Web site and will be distributed upon your arrival for your appointment.
