Patients

Forms

Please view and fill out the forms below prior to your visit. You have the option of printing then completing the forms by hand or filling them out digitally and printing the completed forms. We appreciate your time to prepare for your appointment.

Patient Registration Form

Medical Release Form

Workers Compensation Form


Insurance Information

List of Participating Insurance Providers 

Information for Uninsured Patients


 

Workers Compensation

There are special reporting requirements that must be met to guarantee that the benefits due under workers’ compensation programs are received.

Patients must provide the following:

• Completed Patient Registration Form and Workers Compensation Form.

• Social Security Number.

• Compensation insurance carrier, claim number, contact name, contact phone number(s) and fax number.

• Employer name, HR contact person and phone number.

• Date of injury information and a copy of the first report of injury document.
The document may be faxed by your employer to us at 540-722-4514.

We will provide copies of reports to one party from whom other related parties may obtain their copies.
Unless instructed otherwise, we will assume this is the insurance carrier.


Educational/Informational Brochures

ACL Injuries Presentation

Arthroscopy of Acute Shoulder Dislocation Presentation

Commotio Cordis Presentation

STOP-Sports Injuries Presentation  

What’s New

  • What is a partial knee replacement, and is it right for me?

    Article by Richard J. Patterson, M.D.   Partial knee replacement is a procedure to address the arthritis pain in a limited area of the knee. Physicians divide the knee into three {compartments — patellofemoral compartment, medial tibiofemoral compartment and lateral tibiofemoral compartment. A patient with arthritis can have different compartments affected in a non-unifom fashion. […]

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  • What is a torn hip labrum?

    Article by James W. Larson, III, M.D.   The labrum is a soft ring of cartilage that circles around the hip socket. It’s purpose is to make the hip more stable. It can be torn either in a single accident where the hip is twisted forcefully, or by repetitive damage due to a syndrome known […]

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  • AOSSM In Motion E-Newsletter Winter 2017

    The quarterly American Orthopedic Society for Sports Medicine In-Motion newsletter is now available, this quarter’s featured articles are: | New Treatment for ACL Repair | Stress Fractures in Basketball | Are PRP injections a magic wand for fixing athletes? | Keep Rowing Injuries at Bay | You can click here to read/download it now.

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  • Congratulations to Dr. Courtney

    We are pleased to announce that Dr. Courtney received notification that he has passed the 2016 Recertification Examination.  Dr. Courtney achieved a percentile rank of 100% on his examination.  We at BJSW want to Congratulate Dr. Courtney on this outstanding achievement!

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