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AFFINITY ORTHOPEDICS & SPORTS MEDICINE NEW PATIENT INFORMATION FORM Date: Name: Height: Weight: Phone #: DOB: Address: Reason for Today's Visit: Date of Injury or Onset of Complaints: Is this injury
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How to fill out Affinity Orthopedics & Sports:

01
Start by gathering all necessary information, including personal details, medical history, and insurance information.
02
Fill out the patient demographics section, providing accurate and up-to-date contact information.
03
Complete the medical history section, including any previous surgeries, allergies, current medications, and existing medical conditions.
04
Provide a detailed description of the injury or condition for which you are seeking treatment.
05
If applicable, indicate any specific sports or physical activities that may have contributed to the injury.
06
Fill out the insurance information section, providing the necessary details to ensure proper billing and coverage.
07
Review the form for any errors or missing information before submitting it to Affinity Orthopedics & Sports.

Who needs Affinity Orthopedics & Sports:

01
Athletes - whether professional or amateur, who have sustained sports-related injuries, such as sprains, strains, fractures, or concussions.
02
Individuals with orthopedic conditions - including arthritis, joint pain, tendonitis, or back pain, who require specialized orthopedic care and treatment.
03
Patients in need of surgery - who require surgical intervention for conditions like torn ligaments, rotator cuff tears, or herniated discs.
04
Individuals seeking rehabilitation services - such as physical therapy, occupational therapy, or sports rehabilitation, to recover from injuries and regain optimal function.
05
Patients in need of specialized care - who require personalized treatment plans, orthopedic consultations, or second opinions for complex orthopedic conditions.
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Affinity Orthopedics & Sports is a specialized medical practice that focuses on orthopedic and sports-related injuries.
Affinity Orthopedics & Sports is typically filed by the medical professionals working within the practice.
To fill out Affinity Orthopedics & Sports, the medical professionals need to provide detailed information about the services provided, patient demographics, and billing practices.
The purpose of Affinity Orthopedics & Sports is to accurately report the activities and services provided by the medical practice.
Information such as patient demographics, services provided, billing details, and any relevant medical codes must be reported on Affinity Orthopedics & Sports.
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