Waterbury Orthopaedic Associates: General Information for our Patients

Forms

The following patient information forms may be printed directly from this site, to be filled in at your convenience prior to your appointment. Please be assured that NO medical information is being transmitted over the Internet; you are merely printing a blank form.

Medical History Form

Back Intake Form

Neck Intake Form

Privacy Practices (HIPAA)

Notice of Privacy Practices (Required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996, or HIPAA.)

Acknowledgement of Receipt of Notice of Privacy Practices (You may print this page, sign it, and bring it with you to expedite your appointment.)

Billing and Insurance

Practice Policies and Procedures

Co-pays

Accepted payment types

Insurance form submission

HMOs

Auto and Third Party Insurance

Worker's Compensation

Surgeries

Payment plans

Disability insurance

Pediatric orthopaedic care

Patient checklist for appointments

Financial Policy

Our Financial Policy