Patient Forms Hand & Microsurgery Associates, Inc.
3400 Olentangy River Road, Suite 200
Columbus, Ohio 43202
614 262-HAND (4263)
614-262-0822 (Fax)
 
Patient Medical History Form

Patient Intake Form

Financial Consent HIPPA

Therapy Insurance Information

HIPPA

Medicare Cap

Medicare Secondary Insurance

United Health Care Patient Form

UHC Patient Summary Form

Patient Information Letter

INSTRUCTIONS IF USING OUTLOOK

1.  Open the form
2.  Fill out the form
3.  Click submit form (Outlook will open with the form attached)
4.  Click send
5.  Print if necessary


INSTRUCTIONS IF USING POP3 EMAIL (Yahoo, Gmail, Hotmail, Etc.)

1.  Right click the form and choose Save Target As
2.  Save the file to the desktop
3.  Fill out the form
4.  Click save (you do not need to click the ‘Submit Form’ button)
5.  Open up your email software of choice
6.  Compose a new email to patientinfo@handandmicro.com
7.  Attach the form
8.  Click submit in your email client
9.  Print the form if necessary