Patient Forms

For Your First Visit

Please take the time to read and sign our HIPAA Notice of Privacy Practices and complete the Patient Registration Form, and Patient Health History Form. These forms provide a convenient and easy way for you to complete intake paperwork prior to visiting the physician's office. Upon submission, your answers can be reviewed by the physician and then imported directly into your records.

The Patient Health History Form, Patient Registration Form, and Universal Consent are required for your first visit. You do not need to complete both the online and printable Patient Health History. Please choose whichever version you prefer.

Patient Forms

Patient Education

What to Bring

Required
  • Drivers License
  • Insurance Card
  • Patient Health History Form
  • Patient Registration Form
  • Universal Consent Form
Optional
  • X-rays
  • Cat Scans
  • MRIs
  • Lab Results
  • Referral from your primary care physician
Worker's Comp
  • Employer Information
  • Worker’s Compensation Insurance Information

After illness, injury or surgery, it's important to regain strength and get back to work, play, and the little things you enjoy doing every day – whether you’re an elite athlete, a busy mom, or an active senior. It doesn’t matter what you do, if there’s a reason you can’t do it, we’re here to help. Since 1990, Midwest Sports Medicine has grown to become the premier orthopedic group in Northern Illinois. We offer a team of distinguished, experienced board certified and fellowship trained orthopedic surgeons. We also have a board certified podiatrist, and a pain management specialist. All of our physicians are dedicated to meeting or exceeding your expectations.