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Patient Forms

Print-friendly forms and informational materials for your convenience. Complete forms before your visit to expedite check-in.

Complete Forms Before Your Visit

Bring completed forms to your first appointment to help expedite check-in and ensure we have all necessary information to provide you with the best care.

Questions About Forms?

Call us at 1.833.ORTHOCT and our staff will be happy to assist you with any form-related questions.

Dr. Abiola’s Questionnaire PDF
Work Injury Intake Form PDF
Automobile Accident Report PDF
Liability Injury Intake Form PDF
Patient Information Form PDF
Patient Medical History Form PDF
Ridgefield High School Return to Play Form PDF
Dr. Ciminiello’s Knee Questionnaire PDF
Dr. Ciminiello’s Shoulder Questionnaire PDF
Patient Medical History Form PDF
Patient Information Form PDF
Work Injury Intake Form PDF
Liability Injury Intake Form PDF
Patient Information Form PDF
Patient Medical History Form PDF
Patient Information Form PDF
Patient Medical History Form PDF
Achilles Tendon Injury PDF
ACL Injury PDF
Ankle Sprain PDF
Frozen Shoulder PDF
Lower Back Pain PDF
Meniscus Tear PDF
Patellofemoral Pain PDF
Plantar Fasciitis PDF
Rotator Cuff Tear PDF
Shoulder Impingement PDF
Shoulder Instability / Dislocation PDF
SLAP Tear PDF
Cortisone Injection PDF
Stress Fracture PDF
Tennis Elbow PDF

The following questionnaires are used to aid in the evaluation process. If possible, please fill out the appropriate forms before arriving at our office.

All Orthopaedic Evaluation Patients

Medical History FormPDF
Interim Medical History Form (Established Patient – New Problem)PDF

General Patient Education

Cast Care InstructionsPDF
Interval Throwing ProgramPDF

Ankle Patients

PRE-OP Ankle Surgery InstructionsPDF
POST-OP Achilles Tendon Repair Instructions (page 1)PDF
POST-OP Achilles Tendon Repair Instructions (page 2)PDF
POST-OP Ankle Arthroscopy InstructionsPDF
POST-OP Ankle Fracture InstructionsPDF

Elbow Patients

The DASH (Disabilities of the Arm, Shoulder, and Hand)PDF
PRE-OP Elbow Surgery InstructionsPDF
POST-OP Biceps Tendon Repair InstructionsPDF
POST-OP Elbow Surgery GeneralPDF
POST-OP Elbow Extensor-Flexor Tendon Repair InstructionsPDF
POST-OP Elbow MCL Reconstruction InstructionsPDF
POST-OP Triceps Tendon Repair InstructionsPDF

Hip Patients

PRE-OP Hip Arthroscopy InstructionsPDF
POST-OP Hip Arthroscopy InstructionsPDF

Knee Patients

Dr. Henshaw’s Knee QuestionnairePDF
PRE-OP Knee Surgery InstructionsPDF
POST-OP High Tibial Osteotomy InstructionsPDF
POST-OP Knee Arthroscopy ACL Reconstruction InstructionsPDF
POST-OP Knee Arthroscopy General InstructionsPDF
POST-OP Knee Arthroscopy Lateral Release InstructionsPDF
POST-OP Knee Arthroscopy Meniscal Repair InstructionsPDF
POST-OP Knee Arthroscopy Microfracture Abrasion InstructionsPDF
POST-OP Osteochondral Autograft Transplantation InstructionsPDF
POST-OP Patellar Fracture Repair InstructionsPDF
POST-OP PCL Reconstruction InstructionsPDF
POST-OP Quadriceps Tendon Repair InstructionsPDF

Shoulder Patients

Dr. Henshaw’s Shoulder QuestionnairePDF
PRE-OP Total Shoulder Replacement InstructionsPDF
POST-OP Acromioplasty-AC Joint InstructionsPDF
POST-OP Capsular Release-Manipulation InstructionsPDF
POST-OP Open Shoulder Stabilization InstructionsPDF
POST-OP Rotator Cuff Repair InstructionsPDF
POST-OP Shoulder Surgery ExercisesPDF
POST-OP Stabilization-Labrum Repair InstructionsPDF

Other Surgical Patients

POST-OP Compartment Release InstructionsPDF
Patient Information Form PDF
Patient Medical History Form PDF
Dr. Paul’s Questionnaire PDF
Work Injury Intake Form PDF
Automobile Accident Report PDF
Liability Injury Intake Form PDF
Patient Information Form PDF
Patient Medical History Form PDF
Foot and Ankle Questionnaire PDF
Patient Information Form PDF
Patient Medical History Form PDF
Patient Information Form PDF
Patient Medical History Form PDF

Call OrthoConnecticut today at 1.833.678.4628 to learn more or to schedule an appointment.

At OrthoConnecticut, we offer a comprehensive range of orthopedic treatments and services to address your specific needs.

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