Patient Forms

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Patient 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 Clinic

7301 Hennessy Blvd., Suite 200
Baton Rouge, LA 70808

tel: (225) 766-0050

fax: (225) 766-1499

Walker Clinic

5000 O’Donovan Blvd., Suite 306
Walker, LA 70785

tel: (225) 766-0050

fax: (225) 766-1499

Prairieville Clinic

16158 Airline Hwy. 73
Prairieville, LA 70769

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.