For Patients | R & J Prosthetics & Orthotics

For Patients

For your first appointment with R&J, please be sure to bring in a form of I.D. and your insurance card(s), along with one set of the forms below. 
 

Patient & Practitioner Forms

Click on the form name to view and print.  Please bring the completed forms to your first appointment.  If you need assistance with any of these forms, please contact our office or arrive at least 30 minutes prior to your appointment.  THANK YOU!


New Patients

New Patient Without Medicare New Patients With Medicare Para español

 

Notice of Patient Financial Responsibility    

 

 

Patient Care and Use

Ankle Brace Instructions Halo Instructions Post Op Shoe / Cast Shoe Instructions
Arizona AFO Instructions Hip Orthosis Instructions Prosthesis Use and Care
Carbon Graphite AFO Instructions  HIPPA Notice Silicone Type Prosthetic Liners
Cervical Collar Instructions Knee Orthosis Instructions Spinal Orthoses
Compression Stockings Instructions Knee ROM Brace Upper Extremity/Elbow Orthoses
CRO Walker Instructions Metal AFO-KAFO Instructions Walking Boot Instruction
DAFO Instructions Night Splint Instructions Warrantee and Return
Foot Orthosis Instructions Plastic AFO-KAFO Instructions Wrist Hand Orthoses Instructions