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New Patient Forms

New Patient Forms

New patient forms provide us with information about new patients including allergies, medications, family medical history, and more to help us asses your condition and make the best decisions for your care.

HIPAA

The health insurance portability and accountability act provides federal protections for personal health information held by covered entities. Gavin Orthopaedics is HIPAA compliant.

Questions about forms? Give us a call.

Having problems deciding which form to fill out? We would be happy to answer your questions.

Give us a call at 843-681-5077

"ACL Made Wonderful. I visited Dr. Gavin for a ACL repair. He was thoughtful and insightful with advice to me in regards to my torn ACL. He encouraged me to rehab prior to my surgery. His knowledge and experience shown through by explaining to me that after the surgery it is imperative to rehab my knee to get the best results. His staff followed up with me and helped me get settled with a physical therapy group." ER Patient

Patient Forms

For your convenience, this section of the Gavin Orthopaedics website contains some of our forms. Feel free to print them and fill them out prior to your visit to save you time upon your visit.

We recognize that a quality medical experience also requires excellent administrative support. From the moment you enter Gavin Orthopaedics at the Sport and Spine Institute to the completion of your care, our staff will help you make appointments, answer all of your questions, help you understand your medical bill and insurance coverage, and provide other support you may need.

Forms

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please print and complete these forms prior to your upcoming visit and bring them with you to our office at the time of your visit.AdobeReaderDownload


 

Download forms using the links below:

Fill Out and Fax/Email Forms

Fill out a form and Fax or Email it and your request will be processed within 24 hours, during normal business hours, Monday - Friday, 8:00 am - 4:00 PM, excluding holidays. If you do not receive confirmation of your request within 48 hours, please contact our office at 843.681.5077. Our Fax number is 843 681-5012.

Download forms using the links below:

* Appointment Request/Cancellation
* Gavin Orthopaedic Privacy Notice
* Patient Referral
* Patient Satisfaction Survey
* Prescription Renewal

 

New Patient Forms

Download and print out ALL FIVE of the forms below and bring them with you to your first appointment.

1. Gavin Orthopaedic Privacy Notice
2. New Patient Packet

3. Download and print out and fill the most appropriate form that pertains to your condition below. Dr. Gavin sees up to TWO problem areas in one office visit. Please call us at 843-681-5077 if you have any questions.

   * Initial Visit Back Neck
   * Initial Visit Foot Ankle
   * Initial Visit Hand Wrist
   * Initial Visit Hip
   * Initial Visit Knee
   * Initial Visit Shoulder
   * Initial Visit All Others

 

Established Patient Forms

Download forms using the links below:

* Appointment Request/Cancellation Form

* Established Patient Visit Back Neck
* Established Patient Visit Foot Ankle
* Established Patient Visit Hand Wrist
* Established Patient Visit Hip
* Established Patient Visit Knee
* Established Patient Visit Shoulder
* Established Patient Follow-up Visit
* Established Patient Hip and Knee Follow-up Visit


Request Medical Records/X-rays/MRI's etc.

Please fill out the following form completely in order to request Medical Records, X-Ray or MRI images.  All requests will require an authorization to release Medical Records form completed.   Gavin Orthopaedics makes every effort to fill requests promptly, but we ask for at least a 48 hour business day window to fill your request.

Download form using the links below:

* Medical Request Form
* Appointment Request Form

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