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Patient Forms

  • Patient Intake

    At Flex Orthopedics, our patient intake form serves as a crucial tool for gathering vital information from individuals in need of orthotic and prosthetic care. This comprehensive document covers personal details, medical history, current symptoms or concerns, and consent for treatment. Our commitment to your well-being begins with this form, as it enables us to tailor our services to your specific needs and ensure your safety throughout your healthcare journey.

  • Advance Beneficiary Notice of Noncoverage

    Advance Beneficiary Notice of Noncoverage

    At Flex Orthopedic, we want our patients to be fully informed about their healthcare choices. That's why we use the Advance Beneficiary Notice of Noncoverage (ABN) when necessary. This notice is provided to Medicare beneficiaries when we anticipate that Medicare may not cover a specific orthotic or prosthetic service, item, or procedure. It serves to clarify the patient's financial responsibility and ensures they understand the potential out-of-pocket costs involved. We believe in transparency and empowering our patients to make well-informed decisions about their orthopedic care.

  • Limbs For Life Application

    Limbs For Life Application

    Limbs for Life is a non-profit organization dedicated to providing access to prosthetic care for individuals who have experienced limb loss and cannot afford the necessary prosthetic limbs. They aim to improve the quality of life for amputees by offering financial assistance, support, and resources to help them regain mobility and independence. Limbs for Life plays a crucial role in ensuring that limb loss does not hinder individuals from living fulfilling and active lives.