New Patient Forms

Please click to downloads New Patient Forms below...

For All Patients

A. Information Letter
B. Medication History Form
C. Patient Information Intake Form
D. Self Reporting Pain Tool
E. UC Irvine Medical Center Map

Preoperative Patients

F. Preoperative Anesthesia Screening Form
Orthopaedic Specialty Form

G. Orthopaedic Patient History
Dr. Khoury
Dr. Ross
Dr. Tynan
Dr. Zamorano
The Lower Extremity Clinic
Trauma Fracture Clinic

H. Spine New Patient Form
Dr. Bhatia
Dr. Kiester
Dr. Rosen
The Spine Clinic

I. Hand & Wrist New Patient Form
Dr. Jones
Dr. Rafijah
The Upper Extremity Clinic (hand and wrist)

J. Shoulder & Elbow New Patient Form
Dr. Gupta
The Upper Extremity Clinic (shoulder and elbow)

K. Joint Replacement Surgery

Information Letter (Spanish)

Medication History Form (Spanish)

Orthopaedic Patient History (Spanish)