Patient Forms

Patient Center
Patient Registration Forms

These forms are in Adobe Reader PDF format and require that you have Adobe Reader installed, which can be downloaded for free. Click here to download Adobe Reader.

Patient Information / Medical History Form
Designation of Personal Representative
Authorization for Release of PHI
Pain Diagram
Medical Records Request Form

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Baton Rouge

7301 Hennessy Blvd., Suite 200

Baton Rouge, LA 70808

tel: (225) 766-0050

fax: (225) 766-1499

Walker

5000 O’Donovan Blvd., Suite 306

Walker, LA 70785

tel: (225) 766-0050

fax: (225) 766-1499

Prairieville

16158 Airline Hwy. 73
Prairieville, LA 70769

tel: (225) 766-0050

fax: (225) 766-1499

Brusly

4463 Hwy 1 S
Brusly, LA 70719

tel: (225) 766-0050

fax: (225) 766-1499

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Bone & Joint Clinic of Baton Rouge, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Click to view our notice.