Patient Forms

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

  • Insurance Card
  • Photo ID
  • Referrals (If required by your insurance)
  • Co-Payments (If required by your insurance)

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

History of Present Illness (PDF)

Information Release Form (PDF)

Patient Financial Policy (PDF)

Medication List (PDF)

Parental Consent Form (PDF)

Notice of Privacy Practices (PDF)

Medical Records Request (PDF)

Barrington Orthopedic Specialists 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.

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