WE ARE COMMITTED TO MAKING HEALTHCARE BETTER AND EASIER FOR YOU.

Hand and Microsurgery Associates: Patient Forms
For your convenience, we have implemented a simple and easy way for our patients to check in. No more time consuming registration paperwork. This gets you to your appointment faster and keeps your personal information secure and accurate.

For Your Appointment
PLEASE PRINT and COMPLETE the Medical History form below and bring to your appointment. This allows a friend or family member to assist in completing the form if your injury makes it difficult. Also bring your Driver’s License (or other government issued photo ID) and Insurance Card(s).

Medical History Form – English

Medical History Form – Spanish

**Forms cannot be submitted electronically.

(Need Adobe Reader? Click here to download.)

For MRI Patients
Based on the care you require, please select one of the links below to download your screening questionnaire.

Upper Extremity Questionnaire
Lower Extremity Questionnaire

For PMMN Patients
Dr. Strakowski (PMMN) Consent Form
Dr. Strakowski (PMMN) Medical Questionnaire
Dr. Strakowski (PMMN) Registration and Consent Forms