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, including Submittal Directions, Fax and Telephone Numbers
  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 the following two forms.

  1. Patient Request for Medical Records Release
  2. Patient Records Information, including Submittal Directions, Fax and Telephone Numbers

Miscellaneous Forms

Sheyan J. Armaghani, M.D. — Spine Surgery

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

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

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

Dr. Gasser’s existing patients may download their form from this site. All other patient 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

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

Hassan R. Mir, M.D., MBA, FACS — Orthopaedic Trauma

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

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.

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

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.

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.

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 new patient is required to complete the form(s) listed below.

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.

Syed M. Zaffer, M.D. — Physical Medicine & Rehabilitation / Pain Management