Phone: 614-262-4263 (HAND)

Patient Forms

We are committed to making healthcare better and easier for you.

Hand and Microsurgery Associates: Patient Forms

For your convenience, we have implemented a simple and easy way for our patients to check in. No more time consuming registration paperwork. This gets you to your appointment faster and keeps your personal information secure and accurate.

For Your Appointment

PLEASE PRINT and COMPLETE the Medical History form below and bring to your appointment. This allows a friend or family member to assist in completing the form if your injury makes it difficult. Also bring your Driver’s License (or other government issued photo ID) and Insurance Card(s).

Medical History Form 

**Forms cannot be submitted electronically.

(Need Adobe Reader? Click here to download.)

For MRI Patients

Based on the care you require, please select one of the links below to download your screening questionnaire.

Upper Extremity Questionnaire
Lower Extremity Questionnaire

For Referring Physicians

Referring physician offices may download the form below or visit Medical Professionals for our convenient online form and additional information.

Physician Referral Form

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Available 24 hours a day.

We’re the only group of specially trained hand surgeons in Central Ohio who provide on-call emergency care, 365 days a year.

One-stop care resource.

Our on-site surgery and therapy centers allow us to provide patients with comprehensive, advanced treatment in one convenient location.

Referrals not required.

While we strive to keep your primary care physician informed of the care you receive, we are happy to see you without a referral.