Welcome to Danville Orthopedic Clinic!
This form is for all patients scheduled to be seen.

Patient Information
This form provides DOC with general patient information, including name, address, medical insurance, etc.

Financial Policy
This form allows DOC to file insurance claims and to release information concerning payment benefits to physicians.

Health History Form (Pages 1 & 2)
Please provide health history and current medications so that DOC may properly serve you.

Notice of Privacy Practices (HIPAA)
This HIPAA notice describes what medical information may be used and disclosed. Please read and sign.

Consent to Release Medical Information
This says you have been provided the DOC Privacy Policy. It also tells us to whom we may release your medical records.

Auto Accident Information
This form is to be used by patients needing to report injuries sustained in an accident.

Injury Information Questionnaire
Please complete this form in full so that your insurance claim may be properly processed.

Workman's Compensation Information
Completion of this form is required in order to properly process your insurance claim.