Please print and complete the appropriate form below, and bring to your consultation for your doctor and nurse to review. It will provide the basic background orthopedic health information that will be a confidential part of your medical record.
- EMR Orthopedic Health History Form (English and Spanish) - For new patients.
- Established New Orthopedic Problem (English and Spanish) - For patients that have been seen in Orthopedics within the past 3 years, but have a new condition that needs to be addressed.
- Post Op/Follow up Visit - Please complete for every follow-up or post-op visit.
We Want To Hear From You
Send us our comments or questions, or call us at
*By using this form to communicate with austin Regional clinic (ARC), the information will be transferred over the internet. ARC uses Transport Layer Security (TLS) encryption in order to secure the information you send to us over the internet. There may be times when we cannot respond to your request in email format and another method of communication will be used. For your privacy, please consider the information you include, and who, besides you, may have access to your email account.