Patient Forms
Please click on the documents below to prepare for your upcoming appointment or surgery.
Health History Form
Please visit our patient portal for a printable health history form that you can complete and bring to your next appointment.
Pre-Operative Forms
If you are having surgery at Fox Valley Orthopedic’s Ambulatory Surgery Center (ASC) please download and complete the below disclosure form. If needed, it can be faxed to: 630-443-2063
Request Your Medical Records
Use this form to request medical records. Please note that some records may require a fee. Once completed, fax to: 630-584-1733 or drop it off at one of our three locations.
Disability / FMLA Forms
If you would like to request the completion of a Disability form or FMLA form, please complete this authorization form, including the fee, and drop it off at one of our eight locations, email info@fvortho.com, or mail it to:
Fox Valley Orthopedics
ATTN: Medical Records Department
2525 Kaneville Road, Geneva, IL, 60134
MRI Minor Authorization Form
This is for patients who are 17 years or younger and coming with someone other than a parent, please complete this form and fax to 630-828-5999.