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Patient Services at Jewett Orthopaedic Clinic

We want to make your experience with us as simple and efficient as possible. By downloading patient forms located in the gold box below, our office will have the opportunity to properly prepare for your arrival. Please complete and fax everything within this box that applies to you, our patient. Our fax number is (407) 643-2801

Welcome to Jewett Orthopaedic Clinic!

If you are a new patient to Jewett, (age 18+), please complete the following information.

Patient Registration Information (all new patients)

Consent to Use or Disclose Protected Health Information (all new patients)

Consent for Electronic Prescribing (all new patients)

Assignment of Benefits and Direction for Payment and Assignment and Lien for Medical Services Rendered (all new patients)

What are Fracture Care Charges?

Authorization for Obtaining Records

Please download and fill out the form provided.

Authorization for Obtaining Outside Records and/or Diagnostic Films

Treatment Authorization for Minors

MRI Registration Form

Please download and fill out the form provided.

MRI Registration Form

Request for Copies of Radiology (X-ray films/CD's)

Please download and fill out the form provided.

Request for Copies of Radiology Films/CDs

PT, EMG Services

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