(205) 345-0192
1-800-218-4862
PO Box 2447
Tuscaloosa, AL 35403
  • Home
  • About Us
    • UOC Health Notes
  • Meet the Physicians
  • Specialties
    • General Orthopaedics
    • Arthroscopic Surgery
    • Foot and Ankle
    • Hand and Wrist
    • Joint Replacement
    • Knee & Hip
    • MRI Services
    • Neck & Spine
    • Shoulder & Elbow
    • Spine Surgery
    • Sports Medicine
  • Patient Info/Links
    • Patient Education
    • New Patient Forms
    • Established Forms
    • Physical Therapy Only
    • Patient Referral
    • Medical Record Release Forms
  • Staff & Services
    • Athletic Trainers
    • MRI Technologists
    • Physical Therapists
    • Physician Assistants
    • X-Ray Techs
    • Onsite Services
  • Contact Us

New Patient Forms

PDF

 

 

 

 

 

 

 

 

Patient Information (Green Sheet)

Authorization for Release of Medical Information

Medication Form

Financial Policies

Notice of Privacy Practices

Medical Cost Agreement

 

Medicare Insurance Information Questionnaire-If applicable

To All Medicare Patients-If applicable

 

Buckley and Sudduth Patients Only-Pain Form

 

Workers Comp Patients-Patient Questionnaire

Health Notes
  • Ankle Sprains
  • Joint Repair and Replacement
  • Carpal Tunnel Syndrome

Locations
305 Bryant Drive East, Tuscaloosa
400 Bryant Drive East, Tuscaloosa
2702 Hospital Drive, Suite 101 Northport
Fayette Medical Center
Pickens County Medical Center
Bryan W. Whitfield Medical Center
Bibb County Medical Center
Privacy Policy of UOC
We respect patient confidentiality and we are required by the State of Alabama and Federal law to maintain the privacy of your protected health information (PHI). Your health record contains PHI about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. The new notice will be effective for all PHI that we maintain at that time. Should our privacy notice change, we will post any revisions.
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