Forms For All Our Patients
This page is an easy reference for all types of forms.
If you have any questions about being or becoming a patient at Golden State Orthopedics & Spine, please call one of our local patient contact centers in the city closest to you. Our telephone support staff are always ready to help.
NOTE: IF YOU ARE A LOS GATOS, CAPITOLA, MORGAN HILL OR WATSONVILLE PATIENT, PLEASE DO NOT FILL OUT THESE FORMS, YOU WILL BE GIVEN A DIFFERENT PATIENT REGISTRATION FORM AT THE TIME OF YOUR VISIT. THANK YOU!
These forms are for new orthopedic clinic patients. If you are a Physical Therapy or Occupational Therapy patient at any of our clinics, you do not need to complete any of these forms. Thank you!
NEW PATIENT FORMS
1. NEW PATIENT HEALTH HISTORY
GO TO
HEALTH HISTORY FORM
This form must be completed prior to your appointment. Please bring your completed form with you when you check in. If you do not bring the form, your appointment may be delayed or rescheduled. Thank you !
2. NEW PATIENT MEDICATIONS RECORD
GO TO MEDICATION RECORD
This form is where you list your medications and must be completed prior to your appointment. Please bring your completed form with you when you check in. If you do not bring the form, your appointment may be delayed. Thank you !
3. NEW PATIENT PRIVACY NOTICE
GO TO PRIVACY RECEIPT
Please read THIS PRIVACY PRACTICES PDF then download and sign the Privacy Receipt Form from the link above. Please bring the complete form with you to your appointment to avoid any delays for yourself or other patients. Thank you!
4. NEW PATIENT FINANCIAL POLICY
GO TO FINANCIAL POLICY
Please download the Financial Policy Form, read and sign it. Please bring your completed form with you when you check in to avoid any delays for yourself or other patients. Thank you !
FULL NEW PATIENT PACKET
If you prefer to access all the forms and signature pages in one document, you can download the entire patient packet.
This document contains all the reading and all the forms (1-6) above in one PDF. Please download, read and sign where needed then bring this entire document with you to your first appointment. Thank you! We look forward to taking care of you.
CURRENT PATIENT FORMS
UPDATE DETAILS FORM
GO TO UPDATE FORM
Please download and complete this form and either bring it with you to an appointment or email it to us. E-mail this form to us now.
REQUEST MEDICAL RECORDS
GO TO REQUEST PAGE
To request copies of your medical records, including either notes or images (X-Rays, MRI etc) please visit the request page. Thank you.
OTHER FORMS
CREDIT CARD FORM
GO TO CREDIT CARD FORM
This form can be used to enter your credit card details and send to us to make a payment.