Lake Norman Orthopedic Spine Center Forms

Please print out the patient forms and then bring the completed forms with you to your appointment. This will help you save valuable time

History Packet

History and Physical Form (First visit and New concerns): View or Download Document
e-Prescribing and Medication History: View or Download Document
Dear Patient Letter: View or Download Document
HIPPA Consent: View or Download Document
Consent to Treat: View or Download Document
Notice of Privacy Practices: View or Download Document
Discharge Instructions: View or Download Instructions

Instructions

Instructions for Patients Scheduled for Procedures: View Document

Neck Patient Complete Packet

If you are being seen for your neck please complete the questionnaire below and bring it to your appointment.

Neck Disability Index: View or Download Form

Back Patient Complete Packet

If you are being seen for your back please complete the questionnaire below and bring it to your appointment. 

Back Pain Disability Index: View or Download Form

Referring Patients

To make a referral, please fax back a quick referral form. Our staff will contact the patient directly to set up the appointment. Please include all medical records, imaging studies, as well as a copy of their insurance card to expedite the process.

NOTE: For urgent referrals we can often get your patient in the same day. Please contact our office directly (704) 660-4750.

Referral Form: View Document

Directions

Directions to the Office: View or Download Form