At Muir Orthopaedic Specialists, we know that your time is valuable.
As a new patient to our practice, there are a number of forms you will need to complete for your first appointment. To save you time, we offer the majority of these forms online for you to complete before your appointment.
Your patient care and input are very important to us. If you have any questions please call or contact us online.
We thank you in advance for having these forms prepared prior to your arrival at Muir Orthopaedic Specialists and look forward to having you as our patient.
New Patient Checklist
If you are new to MOS, please complete the steps below.
1. Schedule an Appointment
It’s easy to request an appointment at MOS, just choose from the two options below:
A. Request an appointment online
New patients wishing to obtain an appointment can complete the Online Appointment Request Form. We will call you back the same or next business day to schedule your appointment.
B. Call to request an appointment
If you would like to request an appointment via telephone, call our office and tell the Patient Service Representative that you would like to schedule a new patient appointment. When you call, please have the following information available:
- Patient name, address, telephone number
- Insurance information (have your insurance card in front of you)
- Name of the referring physician, office address, telephone and fax numbers (if applicable)
- Reason for visit
- Date of Injury and how it occurred
- How the diagnosis was made (physical exam, other)
- What treatment, if any, has taken place (x-rays, MRI, etc.)
2. Complete the new patient forms
You can save time at your scheduled appointment by completing the following new patient forms before you arrive at our office.
- Submit the New Patient Registration Form 48 hours in advance of your appointment
- Download, print and complete the medical history forms:
- Download, print and read the Notice of Privacy Practices
- Complete the Acknowledgment of Privacy Practices and have your signature witnessed by a MOS representative.
- Download, print and sign the MOS Financial Policy Form.
New Physical Therapy & Rehabilitation Patients – Please complete all forms below and bring them with you to your appointment.
- Patient Medical History Form
- Authorization for Outpatient Treatment
- Facility Acknowledgment
- MEDICARE PHYSICAL THERAPY PATIENTS ONLY – Pain Disability Questionnaire (en Español: Dolor Cuestionario de Discapacidad)
- ALL HAND THERAPY PATIENTS – Disabilities of the Arm, Shoulder and Hand – The DASH form covers symptoms as well as your ability to perform certain activities.
Current patients – If you have been seen at MOS before, please use the Patient Information Update Form.
3. Come to your appointment
Please arrive 20-30 minutes prior to your appointment time in order to complete any other addition paperwork. Please note that an adult must accompany patients who are under age 18.
What to bring to your first appointment:
- Completed patient forms (Health History, Acknowledgment of Privacy Practices, Financial Policy, etc.)
- Photo ID (drivers license, passport, etc.)
- Current Insurance card(s)
- Your co-pay or co-insurance as indicated by your insurance policy
- Referral or authorization from your Primary Care Physician (PCP), if applicable
- Any available x-rays or diagnostic reports
4. Enroll in the patient portal
Login or enroll in our Patient Portal. Registering only takes minutes and allows patients to:
- Request prescription refills electronically
- Request and view appointments
- Receive electronic statements
- Securely pay account balance
For Referring Physicians
Physicians wishing to refer a patient can submit an Online Patient Referral Form, or fax the patient’s information to 925-933-2912. We will contact your patient to review insurance coverage and obtain additional demographic information.
Complete Your Health History for a Free Gift!
New Patients: Complete your Health History form and bring it with you to your appointment to receive a Muir Orthopaedic Specialists cup!