Forms
For your convenience, we have posted all the forms you may need in order to access our services. Viewing these forms requires that you have Adobe Acrobat. If you do not have Adobe Acrobat, you can click here to download the latest version.
New Patients
Choose the appropriate new patient packet below based on which physician you will be seeing in our office. Please print the packet and complete and sign all documents prior to arriving at the office for your scheduled appointment. There are additional steps to the registration process that must be completed at the office on your first visit, so please be sure to arrive 30-minutes early so that you can make your appointment time.
The following forms are all part of the new patient packet. We have posted them online in case there is a specific form that the office has requested you complete prior to your office visit.
For our internal work-flow, we ask that you please print only one sided when printing the new patient packets.
- Dr. Beyer New Patient Packet
- Dr. Beyer New Patient Packet (Knee) – For patients with knee pain
- Dr. Caillouette New Patient Packet
- Dr. Charlu New Patient Packet
- Dr. Dennis New Patient Packet
- Dr. Desai New Patient Packet
- Dr. Gausewitz New Patient Packet
- Dr. Gausewitz New Patient Packet (Knee) – For patients with knee pain
- Dr. Gazzaniga New Patient Packet
- Dr. Gerken New Patient Packet
- Dr. Gordon New Patient Packet
- Dr. Ip New Patient Packet
- Dr. Lee New Patient Packet
- Dr. Lee New Patient Packet (Back & Neck) – For patients with back & neck pain
- Dr. McNair New Patient Packet
- Dr. Petrie New Patient Packet (Knee) - For patients with knee pain
- Dr. Petrie New Patient Packet (Shoulder) - For patients with shoulder pain
- Dr. Safman New Patient Packet
- Dr. Ting New Patient Packet
- Dr. Tischler New Patient Packet
Other Forms
- Patient Health History
- PRP Patient Information Brochure
An informational brochure for patients considering PRP injections. - Medical Records Release
To obtain a copy of your records, complete this form and mail or fax it to our office at (949) 630-4924. - DMV Disabled Person Placard or Plates (REG195)
DMV Application for disabled person placard or plates. After completing your portion of this form, your doctor will have to complete his/her part before it can be sent to the DMV.
EDD Claim for Disability Insurance Benefits
Newport Orthopedic Institute recommends using the online registration process to complete an EDD Claim for Disability Insurance Benefits in order to expedite filing time. Please click here for registration instructions.