The Hand & Wrist Center
3633 Long Beach Boulevard, Suite 100
Long Beach, CA 90807
Phone: (562) 424-9000
Monday - Friday: 8:00 a.m.–5:00 p.m.
Patient Forms
The forms on this page help our patients get started and decrease the amount of time you will need to spend in our Center during your first visit. If you have any questions while completing these forms, please call us at (562) 424-9000 or send an email to [email protected] .
Needle Aponeurotomy Forms:
- Dupuytren’s Questionnaire
- Procedure Consent Form
- Sharing of Information Signature Consent
- Testimonial Consent
For a downloadable version of our Needle Aponeurotomy brochure, click Patient Brochure.
Patient Forms:
- Patient Registration Form
- Medical History Form
- General Disclaimer Form
- Release of Information Authorization Form
- Medicare – Medi-gap Acknowledgement Form (complete this form if you are a Medicare patient)
- Additional Insurance Form (complete this form if you have two or more insurance plans)
HIPAA Policies and Procedures – Notice of Privacy Practices (Please read and print a copy for your records)
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