Patient Forms: UF Department of Orthopaedics & Rehabilitation

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Patient Forms

To establish e-mail interactions with your provider, please read and complete the "Authorization to use or disclose Protected Health Information via electronic media" form. Please bring the completed authorization with you to your next clinic visit. Download Authorization Form (.pdf)

To help us provide you with better care, please download and print the questionnaire. Please bring the completed questionnaire with you to your appointment. Thank you.

Forms and Questionnaires

OSMI New Patient Medical History Questionnaire
Download Form (.pdf)

OSMI SpineCare Center New Patient History Questionnaire
For SpineCare Patients: Dr. Atchison, Dr. Keole,
Dr. Placer: Download Form (.pdf)

Shands at UF Outpatient Surgery History and Physical Form: Download Form (.pdf)

Shands at UF Physical Medicine and Rehabilitation Procedure
Informed Consent Form: Download Form (.pdf)

Tours of The Orthopaedics Institute
Observation Tour Form: Download Form (.pdf)

OSMI Confidentiality Statement
Confidentiality Form: Download Form (.pdf)

Consultation Request - Referring Physicians
Consultation Request: Download Form (.pdf)

UF Medical Record Release

Our goal is to provide you with excellent customer service. All request for medical records can take up to 10-15 business days for processing. To help avoid unnecessary delays, please fill out the request for records in its entirety. If you have any questions when filling out this form please do not hesitate to call us.

Please return the completed Medical Record Release Form (found below) via our fax number or to the mailing address below:

UF Orthopaedics and Sports Medicine Institute
ATTENTION: Medical Records
Fax: 352.273.7294
Address: P.O. Box 112733
Gainesville, Florida 32611

Medical Record Release Form:
Download Form (.pdf)

Thank you for your assistance and cooperation.

UF Orthopaedic Clinic
Medical Records Staff
Phone: 352.273.7061