Patient Forms

The following forms need to be PRINTED and brought with you to your next visit. Certain forms require yearly updates. Please note if your provider requires alternate forms, those will be available at check-in.

Patient Portal Guide

In this document, you will learn how to use the features in the Patient Portal.

Read the Portal Guide

Patient Demographic Form

This form provides us with information about you, your insurance, and specifics about the nature of your injury or condition. Please go to the Patient Portal to fill out this information.

Go to the Patient Portal

Permission To Accompany A Minor

Please fill out and PRINT this form for any minor who needs to be seen at AOA when a legal parent or guardian is not available to attend the visit.
Download the form

Financial Policy Form

Please read the Financial Policy prior to your first visit. This form helps to answer questions about payment and patient responsibility.

Read the Financial Policy

Medication List Form

Your medication list and pharmacy information can be entered by going to the Patient Portal. If you are being seen and haven’t updated the information in more than 6 months, please go to the Patient Portal and update it.

Go to the Patient Portal

Patient Privacy Notice

Please PRINT and complete the Privacy Notice Form prior to your first visit. This form acknowledges our payment policy and allows you to delegate release of your medical information to another party.

Download the form

Work Comp Appointment Form

This form can be used by Work Comp representatives/case managers who want to schedule initial appointments. Having this information completed when you call will speed up the scheduling process.

Download the form

Disability or FMLA Request Form

All patient forms will need to have a request form on file and brought to our main campus (9828 E. Shannon Woods Street, Suite 100). There is a $35 fee to process all forms. Payment is required before we can process your request.

Download the form