Patient Forms

Initial History

This form can be downloaded and completed prior to your initial visit with your physician.

HIPAA Forms

Patient History (English | Espanol)

This Privacy Notice is being provided to you as a requirement by Federal law, The Health Insurance Portability and Accountability Act (HIPAA), effective April 14, 2003.

This privacy notice describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law.

Use & Disclosure Form with PrivacyAcknowledgement (English | Espanol)

This form tells Resurgens Orthopaedics that you have received the HIPAA privacy notice. The  Use & Disclosure Authorization tells Resurgens Orthopaedics who they may disclose Protected Health Information (PHI) to. The patient or patient representative must complete and sign this notice.

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