(972) 457-1530
Call (972) 457-1530
One Ortho/Patient Intake
Before Your Visit

Patient intake.

Already have an appointment? Fill this out before your visit so we can spend our time together on your knee — not paperwork. Takes about 8 minutes.

Time: ~8 minutes Saves: Auto-saved on this device as you type Need help? Call (972) 457-1530
Submitted

Thanks — we've got it.

Your intake is on its way to our team. We'll review it before your appointment and reach out if we need anything else.

If anything changes — or if this is urgent — call us at (972) 457-1530.

Back to home
About you.

The basics — so we can identify your chart and call you back at the right number.

Please enter your name.
Please enter your date of birth.
Sex

Address

Used for your chart and any mailed paperwork.

How to reach you

Please enter a phone number.
Best way to reach you
Insurance & referral.

We'll verify benefits before your visit. Final insurance and payment specifics are confirmed at check-in.

Do you have health insurance you'd like us to bill?

Insurance details

Snap your card to skip the typing — or fill in below. Whatever's easier. We'll verify everything at check-in.

Heads up: photo uploads aren't saved if you close this page — fill these in right before you submit. The rest of the form auto-saves.

Front of card (optional)
Drop a photo or browse
JPG · PNG · HEIC
Front of insurance card
Back of card (optional)
Drop a photo or browse
JPG · PNG · HEIC
Back of insurance card

Referral & primary care

Were you referred by another doctor?
Why you're coming in.

The clinical specifics — medications, allergies, full surgical history — we'll review at your visit. This is the practical picture so we know what to expect.

Body part(s) bothering you — check all that apply
Which side?
How long has this been going on?
How did it start?

Pain right now (0 = none, 10 = worst imaginable)

No painWorst imaginable

Pain at its worst

No painWorst imaginable
What makes it worse? (check all)
What have you tried so far? (check all)
Imaging done for this issue? (check all)
Do you have the images / report?
A bit about you.

Helps us tailor recovery planning around your life, not a brochure.

Activity level

Emergency contact

Someone we can call in case we need to and can't reach you. Required for any surgical patient.

Please enter a contact name.
Please enter a phone number.
How did you hear about us?
Review & submit.

Look over your answers. Click Edit on any section to make changes.

One last thing.

Detailed medical history — your current medications, allergies, surgical history, and any specific diagnoses — will be reviewed in person at your visit. Bring an up-to-date medication list if you can.