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OrthoCareExpress

Patient Forms 

We have provided print-friendly patient forms and informational material for your convenience. Bring completed forms to your first visit to ensure we get you in and out as quickly as possible. If you have any questions, please contact the office you are visiting.

PDF  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

General Patient Education

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

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

pdf Medical History Form

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

 

General Patient Education

pdf Cast Care Instructions

pdf Interval Throwing Program

 

Ankle Patients

pdf PRE-OP Ankle Surgery Instructions

pdf POST-OP Achilles Tendon Repair Instructions (page 1)

pdf POST-OP Achilles Tendon Repair Instructions (page 2)

pdf POST-OP Ankle Arthroscopy Instructions

pdf POST-OP Ankle Fracture Instructions

 

Elbow Patients

PDF  The DASH (Disabilities of the Arm, Shoulder, and Hand)

pdf PRE-OP Elbow Surgery Instructions

pdf POST-OP Biceps Tendon Repair Instructions

pdf POST-OP Elbow Surgery General

pdf POST-OP Elbow Extensor-Flexor Tendon Repair Instructions

pdf POST-OP Elbow MCL Reconstruction Instructions

pdf POST-OP Triceps Tendon Repair Instructions

 

Hip Patients

pdf PRE-OP Hip Arthroscopy Instructions

pdf POST-OP Hip Arthroscopy Instructions

 

Knee Patients

PDF  Dr. Henshaw’s Knee Questionnaire

pdf PRE-OP Knee Surgery Instructions

pdf POST-OP High Tibial Osteotomy Instructions

pdf POST-OP Knee Arthroscopy ACL Reconstruction Instructions

pdf POST-OP Knee Arthroscopy General Instructions

pdf POST-OP Knee Arthroscopy Lateral Release Instructions

pdf POST-OP Knee Arthroscopy Meniscal Repair Instructions

pdf POST-OP Knee Arthroscopy Microfracture Abrasion Instructions

pdf POST-OP Osteochondral Autograft Transplantation Instructions

pdf POST-OP Patellar Fracture Repair Instructions

pdf POST-OP PCL Reconstruction Instructions

pdf POST-OP Quadriceps Tendon Repair Instructions

 

Shoulder Patients

PDF  Dr. Henshaw’s Shoulder Questionnaire

pdf PRE-OP Total Shoulder Replacement Instructions

pdf POST-OP Acromioplasty-AC Joint Instructions

pdf POST-OP Capsular Release-Manipulation Instructions

pdf POST-OP Open Shoulder Stabilization Instructions

pdf POST-OP Rotator Cuff Repair Instructions

pdf POST-OP Shoulder Surgery Exercises

pdf POST-OP Stabilization-Labrum Repair Instructions

Other Surgical Patients

pdf POST-OP Compartment Release Instructions

PDF  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