Patient Forms | Palm Beach Orthopedic Institute | Spine Surgeon Jupiter

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Patient Forms

Medical Records Forms

Medical Records can be requested using the online form found on the Medical Records page.

Physical Therapy Forms

DASH (Disabilities of the Arm, Shoulder and Hand)

Knee Outcome Survey

LEFS (Lower Extremity Functional Scale)

Low Back Questionairre

Neck Disability Index

Practice Forms

Non-Discrimination Notice

Notice of Privacy Practices

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Dilhan Abeyewardene, MD Fellowship Trained
Hand & Upper Extremity
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Robert J. Avino, MD Fellowship Trained
Total Joint Replacement
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G. Clay Baynham, MD Fellowship Trained
Adult & Pediatric Spine Surgery, Reconstructive Spine Surgery
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Michael Cooney, MD Fellowship Trained
Sports Medicine & Arthroscopy
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Melisa Estes, MD Fellowship Trained
Physical Medicine & Rehabilitation, Interventional Pain Management
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Kenneth Gerszberg, MD Fellowship Trained
Orthopaedic Foot & Ankle
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Brian W. Hill, MD Fellowship Trained
Shoulder & Elbow Surgery
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John Hinson, MD Fellowship Trained
Shoulder & Elbow Surgery
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Justin Kearse, MD Fellowship Trained
Hand/Wrist/Upper Extremity Surgery
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James Kerpsack, MD Fellowship Trained
Pediatric Orthopaedic Surgery
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Michael Leighton, MD Fellowship Trained
Sports Medicine
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Fernando Mora, MD Fellowship Trained
Interventional Pain Medicine
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Andrew R. Noble, MD Fellowship Trained
Total Joint - Knee & Hip Replacement
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Scott Norris, DO Fellowship Trained
Sports Medicine
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Kyle Petersen, MD Board-Certified and Fellowship Trained
Orthopedic Spine Surgeon
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John Schilero, DPM Fellowship Trained
Foot & Ankle Surgery, Fellow American College of Foot & Ankle Surgery
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Andrew Seltzer, DO Fellowship Trained
Foot & Ankle Surgery, Fellow American College of Foot & Ankle Surgery
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Jonathan H. Shaw, MD Fellowship Trained
Hip & Knee Replacement & Revision
Hip & Knee Center
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Gary Wexler, MD Fellowship Trained
Sports Medicine
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