clinic home    dr Whitaker home    health information    affiliations    accepted insurance    meet our staff    meet our doctors    tour our facility    patient forms    Maps    additional resources
			health information search   go
			Jacksonville Orthopaedic Institute     410 Jacksonville Blvd - Jacksonville Beach, FL 32250 - (904) 241-1204   patient forms       Please print the appropriate form, fill it out completely and bring it with you to your appointment.       Map to Our Beach Office   If you have an appointment at our Beach office, print this map       Map to our Point Meadows Office   If you have an appointment at our Point Meadows office, print this map       Patient Information   Please print and COMPLETE this form using BLACK ink. Bring this completed form along with a PHOTO ID, all of your insurance cards and a referral if required by your insurance company.       Patient History Form   Please fill in all blanks on this form using Black ink. Bring this with you to our appointment. This form is used by the Doctor to review your history and treat your current pain/injury       Financial Responsibility Form   Please print & COMPLETE this form using BLACK ink. Bring this completed form with you to your appointment.       HIPAA Acknowledgement Form   Please print & complete this form and bring it with you to your appointment.       Authorization for Disclosure of Health Care Information   Please print and COMPLETE this form. This form authorizes us to leave you voicemail messages. In addition, you can list family & friends with whom we can discuss your medical care, make appointments and pick up prescriptions.       Non-Pregnancy Acknowledgement   If you are a female, please print and sign, and bring with you to your appointment.       Auto Accidents - Initiation of Medical Treatement   If you are being seen for an auto insurance related injury, please fill this form in, top and bottom and bring with you to your appointment.       Medical Records Release Request   If you need a copy of your medical records, X-ray or MRI films, please complete this form. You can fax it back to us at (904)241-7331. You can also mail it, or drop it off at our beach office for processing. Please allow 5-7 business days for us to pull your chart and make all necessary copies. There is a $10.00 CASH fee for each film copied. The CASH fee is due prior to film copies being made.           Some files require Adobe Acrobat Reader to open. Click on the Acrobat Reader icon if you do not have Adobe Acrobat Reader and wish to download it.     top privacy policy legal notice
	Contact Webmaster: AllAboutMyDoc@dpyus.jnj.com © DePuy Orthopaedics, Inc. 2000-2008, All rights reserved.   This site is published by DePuy Orthopaedics. It is intended for visitors from the United States only.