Patient Forms

Thank you for choosing Southern California Orthopedic Institute for your orthopedic care. For your convenience, you may download, print, and complete our required patient forms below. Please remember to bring your completed forms, along with the following pieces of information, to your scheduled appointment:

  • Insurance card
  • Photo ID
  • Referrals (If required by your insurance)
  • Co-payments (If required by your insurance)

Please use the links provided to download and print our patient forms.

New Patient Office Visit

The following documents will assist you in expediting the check-in process for your appointment. We ask that you please print and complete the following forms, and bring them with you to your appointment.

SCOI COVID-19 Visitor Policy
In order to control the number of people in our SCOI areas and minimize exposure and to be able to comply with physical distancing, any SCOI patient is not allowed to bring a visitor with them into any SCOI facility unless they require a caregiver or assistant due to disability or unless they are under age 18 and require an adult. In these instances, only one visitor is allowed. Anyone else is unnecessary and can be communicated with via telephone/email/telehealth. Any other visitors that accompany the patient will be instructed to wait outside our facilities or in their vehicles. All visitors who enter the SCOI building need to complete the Infectious Disease Screening form and have their temperature taken upon entry.

Other Patient Forms

Southern California Orthopedic Institute complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Physical Therapy Center for Rehabilitation Medicine

For physical therapy appointments, please print and complete the following form in order to expedite your check-in process. We ask that you please bring this form with you to your appointment.

MRI

The following form will help expedite your MRI appointment check-in. Please print, complete, and bring this form with you to your MRI appointment.

The latest version of Adobe Acrobat Reader is required to view and print PDF files, and it is available here.