is a proud member of Privia Medical Group. The best doctors in our community have joined together to form Privia Medical Group (PMG), a multi-specialty, high-performance medical group that puts patients first. Our physicians are united by the mission of providing better, more coordinated care for their patients. To learn more about Privia Medical Group and find other Privia doctors, please visit our website.
Patient Forms
1. Notice of Privacy Practices (PDF) – Describes how health information about you (as a
patient of OrthoOIC) may be used and disclosed, and how you can get access to
your individually identifiable health information. Please review this notice carefully.
2. Authorization for Release of Medical Information (PDF) – Allows patients to authorize the
disclosure of their health information to a designated individual, company, agency, or
facility.
3. Authorization and Consent for Treatment (PDF) – All patients must provide their consent
for treatment, communications (calls, emails, and text messaging), and agreement of
financial responsibility.
4. Preferred Contacts (PDF) – Patients are encouraged to complete and return the Preferred
Contacts Form but it is not required.
5. Financial Policy (PDF) – This form advises patients of their complete financial responsibility
for all medical services received without regard to insurance eligibility or coverage
determinations.
