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.
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.
- To Complete a Disability/FMLA Form:
- Please click the link below to begin the disability/FMLA form process; Please DO NOT bring forms to the practice to turn in.
- Make sure to have your disability or FMLA form with you BEFORE logging in! (You should have received these forms from your disability carrier or employer). No forms are provided on this link.
- The normal turnaround time to receive your completed form is 5 business days. There is an additional fee for expedited requests.
- You will be asked for payment on this page as well. The cost is $35 per form, $15 for an updated form, and $50 for an expedited request (guaranteed 3-day turnaround).
- FMLA and Disability forms cannot be completed on the same request. These forms must be submitted separately.
- For any further questions, please contact us at (470) 239-6131 or Disability@MedRecsManagement.com