Patient History Form
Thank you for trusting The Orthopedic Institute of Wisconsin with your healthcare needs! It is our privilege to provide treatment and care for you. Prior to visiting our office for the first time, please use the link below to fill out the online Patient History Form as completely as you are able. It is important that you fill in your First Name, Last Name, Date of Birth and gender (in the same fashion you registered with our scheduling team) in order to attach this important information to your chart. We will also ask to make copies of your insurance card and a form of ID, at the time of your visit.
If you need to complete a disability or FMLA form, please click the link below, and follow the instructions given.
PATIENTS: Due to the very high volume of patients who require FMLA and disability paperwork to be completed and signed by the doctor, we have implemented this platform to assist in the rapid processing of these important and necessary forms. Through this platform, all FMLA and disability forms will be returned to you, digitally, within 5 days. Access and execution from this platform will require a $35.00 fee that is due electronically at the time of order placement. Once complete, your form(s) will be provided to you through a convenient, secure and efficient electronic platform. Your form(s) will also be stored in your electronic chart at the Orthopedic Institute of WI and you will have personal control and access to your form(s) that you will now own.
THIRD PARTIES: There is a charge for disability/FMLA form completion. The requestor of that form completion is responsible for payment. If you are a third party submitting a disability or FMLA request, please fax that request to 615-777-3517. Otherwise, please ask the patient submit the request directly via the link provided below, which will result in a faster turnaround.
If you need a copy of your medical records, please do one of the following:
- Click the ‘CONTACT’ button on our website and request your medical records in a message to our team
- Call our main number (414-384-6700) and ask to speak with someone in our medical records department
The Orthopedic Institute of Wisconsin offers the following advantages, to help make your experience with us positive and convenient:
- On site X-ray and screening; facilitating prompt, complete evaluation of all orthopedic conditions.
- Immediate evaluation of Occupational injuries and Workman’s Compensation cases.
- Office appointments within 24 hours.
- Most insurances accepted. Call your insurance to verify we are listed as a provider.
- Convenient locations throughout the greater Milwaukee area and Southeastern Wisconsin in Franklin and Wauwatosa.
Call (414) 384-6700 for more assistance or immediate appointments, or click here to submit an appointment request form.