Patient Forms
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.
Dublin Patient Contact Center
(800) 943-8099
Los Gatos Patient Contact Center
(408) 412-8100
Oakland Patient Contact Center
(800) 943-8099
Walnut Creek Patient Contact Center
(925) 939-8585
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
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!
Medications 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!
Privacy Notice
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!
Patient 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.
Si prefiere acceder a todos los formularios y páginas de firmas en un solo documento, puede descargar el paquete completo para el paciente.
Este documento contiene toda la lectura y todos los formularios (1-6) anteriores en un PDF. Descargue, lea, y firme donde sea necesario y luego traiga este documento completo a su primera cita. ¡Gracias! Esperamos poder cuidar de usted.
Current Patient Forms
Update Details Form
Please download and complete this form and bring it with you to your appointment.
Request Medical Records
To request copies of your medical records, including either notes or images (X-Rays, MRI etc) please complete an Authorization for Release of Medical Information form. Thank you.
Other Forms
Credit Card Form
This form can be used to enter your credit card details and send to us to make a payment.