Patient Registration Form

Patient Health History and Privacy Form

To avoid long waits prior to your visit please print and complete the following form and bring it with you to your visit.  You may also create a secure e-mail Patient Portal  and then send the completed form to us 3 days prior to your visit (fastest way).


Medical Records Release of Information Forms

Medical Records Release of Information Form

Authorization to send your medical records to Pittsburgh Foot and Hand Center or request a copy of your medical records. You may also request copies of your medical records through your Patient Portal by clicking Medical Records Request.


Patient Privacy Forms

Patient Privacy Policy

Notice of Health Information/Privacy Practices

This Patient Privacy Form (on the bottom of Patient Health History Form) acknowledges that you have read and understand the Notice of Health Information/Privacy Practices of Pittsburgh Foot and Hand Center regarding possible use or disclosure of your medical information.  You may also determine who may receive information about your health care. Please print the form out, sign it and bring/mail this to our office or send it to us through your secure Patient Portal two days prior to your office visit.