The Patient Registration Packet below is available to accelerate the new patient process at MidAmerica Hand To Shoulder Clinic. To access the registration forms, click on the link below and complete the entire packet prior to arriving at our office.
Patient Registration Packet
The Patient Registration Packet contains the following documents:
Patient Registration Form
Patient Privacy Statement
Patient Health History
Insurance Payment Information
Workman's Compensation Information Form
Notice of Privacy Practices
To view these documents, you need access to Adobe Reader. For patients who wish to fill out the Patient Registration packet online, click the link above and edit the forms on your computer. Print the completed forms, in the packet, and sign where necessary before presenting them at our office.
Click on the icon to download the latest version of Adobe Acrobat Reader.