Patient Forms/Online Registration
Online Patient Registration Form
Click on this link to access a secure web form version of the required patient medical history paperwork. We created this online option for your convenience and ease of use. You will receive a confirmation upon successfully submitting the form to Youngstown Orthopaedic Associates.
At Youngstown Orthopaedic Associates, we are continually striving to improve your experience when visiting our practice. To facilitate this, we ask that you complete your required paperwork and send it to us at least 5 days prior to your scheduled visit.
We will require:
1) A completed Demographics form;
2) Your complete Patient Medical History form
3) A signed Privacy Practices (HIPAA) Consent Form, and
4) A signed Financial Policy.
The Demographics and Patient Medical History forms can be completed using the Online Patient Registration Form.
A combined Privacy Practices and Financial Policy form will be presented to you upon your visit for signature. You can review these Practices and Policies prior to your visit by clicking on the appropriate pdf form below.
If you prefer, you can print the Patient Medical History form for completion and either fax it to 330-729-2758 or mail it to Youngstown Orthopaedic Associates, 6470 Tippecanoe Road, Canfield, OH 44406. Either way, we do need this information at least (5) days prior to your scheduled appointment.
Any delay will cause you to wait until all of your paperwork is entered into our Electronic Medical Records system prior to your visit with the doctor. Depending on the day, this could add one hour to your visit.
Please take time to review the forms and sign in the appropriate areas.
Miscellaneous Medical Forms
Forms – General Paperwork
Need a PDF Document Reader? Click the Get Adobe Reader to download the latest version for your computer and operating system.