GREENWOOD ORTHOPAEDICS PC MEDICAL INTAKE FORM 2026

1. Click ‘Get Form’ to open the GREENWOOD ORTHOPAEDICS PC MEDICAL INTAKE FORM in the editor.
2. Begin by filling out the DEMOGRAPHICS section. Enter your name, date of birth, sex, occupation, height/weight, marital status, referring physician, and hand dominance.
3. In the REASON FOR VISIT section, clearly state the main reason for your visit today. Use the provided space to elaborate if necessary.
4. Complete the PAIN DIAGRAM by indicating areas of pain using the designated symbols (P for Pain, N for Numbness, etc.).
5. Assess and circle your pain severity on a scale from 0 to 10 in the SEVERITY section. Describe the nature of your pain by checking appropriate boxes.
6. Answer questions regarding how your condition affects daily life and note any factors that increase or decrease your pain.
7. Provide details about your current injury in the DETAILS OF THE CURRENT INJURY section. Include how it occurred and where it happened.
8. Fill out sections on THIRD PARTY LIABILITY if applicable, detailing any insurance claims or legal actions related to your injury.
9. List any diagnostic tests and treatment history relevant to your condition in their respective sections.
10. Finally, complete sections on CURRENT MEDICATIONS and ALLERGIES before signing at the bottom of the form.

Start filling out your GREENWOOD ORTHOPAEDICS PC MEDICAL INTAKE FORM online for free today!