Patient Forms | Academy Orthopedics
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Patient Forms

 

New Patient Forms

Please click the buttons below to fill out new patient forms electronically. All patients must fill out the Patient Demographic Packet. If you are seeing Dr. Seidman or Dr. Duckett, or for anything not pertaining to upper extremity, please fill out the General Medical History form. If you are seeing Dr. Katz for upper extremity only, please fill out the Upper Extremity Medical History form. There is no need to fill out both the Upper Extremity Medical History and the General Medical History.

 

 

Returning Patients

For patients seen within the past year but are experiencing a new problem, please fill out one of the forms below. For anything pertaining to the lower extremity, or if you are seeing Dr. Seidman or Dr. Duckett, please fill out the Est. Patient New Problem form. For patients seeing Dr. Katz for upper extremity only, please fill out the Est. Patient Upper Extremity form.


Request Medical Records

If you would like to obtain a copy of your medical records, please fill out a request on our secure records request form. Once received, records will be available for pick up or by mail within 10-14 days. Please note there is an associated charge for medical records. Our Records Clerk will call you and go over any applicable charges once your form has been received.


FMLA/Disability Paperwork

If you are needing FMLA or disability paperwork for yourself or a family member, please submit all info via our secure online form. Please note, there is a $50 fee for all disability and FMLA forms to be completed. Our FMLA Coordinator will reach out to you to collect payment and discuss next steps once our online form is received. Once completed, our policy is a 7 – 14 day turn around. We ask that you allow us this timeline for your forms to be reviewed, filled in and signed off by your physician. Our office will contact you when forms have been completed. Multiple status updates aren’t necessary unless the deadline date has passed, and you have yet to hear from us within the 14 days of receipt of your forms.


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