Patient Forms

Thank you for choosing Black Hills Orthopedic & Spine Center for your orthopedic care. For your convenience, you may download, print, and complete our required patient forms below. Please remember to bring your completed forms, along with the following pieces of information, to your scheduled appointment:

  • Current insurance cards
  • Current photo ID
  • Any pre-authorizations obtained from your insurance company
  • Medicaid card
  • Referral, if applicable*
  • Insurance co-payment, co-insurance, and/or deductible information, if applicable

*Please verify that our office has received the referral prior to your appointment. Having a copy of your insurance referral is recommended.

Please use the links provided to download and print our patient forms.

General Forms

Patient Forms/Notice of Privacy Practices (PDF)

Authorization for Use/Disclosure of Protected Health Information (PDF)

Injury Form (Dr. Giuseffi) (PDF)

Cervical Form (Dr. Woodruff) (PDF)

Lumbar Form (Dr. Woodruff) (PDF)

Scoliosis Form (Dr. Woodruff) (PDF)

Physical Therapy Post-Operative Guides

ACL Reconstruction (PDF)

Rotator Cuff Repair (PDF)

Total Hip Exercises (PDF)

Total Knee Exercises (PDF)

Injury Prevention Handouts

Back Health Class (PDF)

Throwers Program (PDF)

Black Hills Orthopedic and Spine Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

The latest version of Adobe Acrobat Reader is required to view and print PDF files, and it is available here.