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https://www.drkhalfayan.com/pre-appointment-forms/

New Patient Instructions and Forms

Thank you for trusting Dr. Khalfayan as your Orthopedic doctor. We want you to get the most out of your appointments with us. Let’s get started!

Patient Forms

Please make sure to read and print out all forms and have them ready for your first appointment.

  1. HIPPA Privacy Policy
  2. HIPPA Signature Page
  3. OPA Financial Policy
  4. Patient Registration Interactive (OPA Patient Reg Interactive)
  5. Authorization to Leave Personal Health Information (OPA PHI Web)
  6. Patient Medical History Interactive (OPA PMH Interactive)

What to Bring

In preparation for your appointment with Dr. Khalfayan, we ask that you bring the following.

  1. Any X-rays, MRI scans, or other diagnostic tests related to your condition or injury. 
  2. Reports from previous surgeries for the condition or injury you are being seen for.
  3. Any notes of previous evaluations for the condition or injury you are being seen for.

What to Wear

  1. Please bring or wear shorts for evaluation of a lower extremity condition or injury (i.e. knee injury).
  2. For females, please bring or wear a tank or halter-top for a shoulder evaluation.

We look forward to seeing you!
 

Need to cancel your appointment?

We ask that you please cancel at least 1 day ahead of your scheduled appointment time by calling our office at (206) 386–2600.