I hereby authorize New Edge Orthopedics, LLC to use and/or disclose a copy of my medical records containing individually identifiable health information as described below. | understand that this authorization is voluntary. | also understand that, if the organization authorized to receive the information is not a health care provider or health plan, the released information may no longer be protected by state or Federal privacy laws or this authorization.
By filming my name here and clicking submit, I accept that my entered name is a legal signature agreeing to the terms as described above
Please check any conditions that you have had in the past or have currently
How you were injured?
Date of injury:
Body Parts injured (include right or left):
Please describe how the injury occurred and where on the date you listed above:
Signature of Patient or Guardian:
As you are aware, due to the current COVID-19 coronavirus pandemic, we must make every effort to insure that all safety measures have been taken to protect our patients, staff, and families.
It is mandatory that the following COVID-19 screening form is filled out by every patient and submitted prior to every office visit.
Please fill out this form to the best of your ability and as truthfully as possible to help us maximize the safety of our patients, staff, and families. Answering yes to any of the screener questions does not mean that service will be denied.
To all our friends, families, patients, and supporters, we are blessed to report that New Edge Orthopedics, LLC is back on track and reopened while making accommodations in response to this unprecedented challenge/ pandemic. We are exercising great care ensuring that we provide the safest environment possible for our patients, staff, and families including:
We look forward to celebrating unity as we work together fighting this pandemic while providing the Best Orthopedic Sports Medicine and Joint Preservation care to our Patients and Family.
Stay safe & healthy!
All of us at NEO
Please click on one of the three options below that does describe you