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http://drkhalfayan.com/pre-appointment-forms/

New Patient Instructions and Forms

We want you to get the most out of your appointment with us. In order to accomplish this, it may be helpful to review your condition or injury on our website and write down any questions you may have.  We want to perform a thorough evaluation and ask that you complete all forms in their entirety and review the information below on what to bring to your appointment.

What to bring to your appointment:

  • Any X-rays, MRI scans, or other diagnostic tests related to your condition or injury. Please bring actual X-rays/scans in addition to the reports. CD format is preferred.
  • Operative reports of previous surgeries for the condition or injury you are being seen for.
  • Any notes of previous evaluations for the condition or injury you are being seen for.
  • Please bring or wear shorts for evaluation of a lower extremity condition or injury (i.e. knee injury).
  • For females, please bring or wear a tank or halter-top for a shoulder evaluation.
  • Your completed forms

 

HIPPA Privacy Policy

HIPPA Signature Page

OPA Financial Policy

Patient Registration Interactive (OPA Patient Reg Interactive)

Authorization to Leave Personal Health Information (OPA PHI Web)

Patient Medical History Interactive (OPA PMH Interactive)