Orthopedic Surgery Center

New Patient Intake

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Welcome to Your New Patient Intake

Please complete this intake before your visit. You can save and resume anytime. For help, contact our office at (000) 000-0000 or intake@orthocenter.example.

Before you begin

  • This form takes approximately 15-20 minutes to complete.
  • Your progress is saved automatically as you go.
  • Have your insurance card and medication list available.
  • All information becomes part of your medical record.

Optional Contact Information

Your information is protected under HIPAA. This form uses encryption to keep your health information secure and private.