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  •   (937) 398-1066
  • Make an Appointment
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  • Patient Forms
  • Patient Portal
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  • Meet Our Providers
    • Ian M. Thompson, MD, MS, FAAOS
    • David Galluch, MD, FAAOS
    • Ahmed Khan, MD
    • Amie Beals, PA-C
    • M. Matthew Milam, PA-C
    • Lindsay Johnson, PA-C
  • Services & Specialties
    • General Orthopedics
    • Sports Medicine Primary Care
    • Hip & Knee
    • Shoulder & Elbow
    • Hand & Wrist
    • Fractures & Trauma
    • Birmingham Hip Resurfacing
    • Osteoporosis
  • On-Site Facilities
  • Testimonials
  • Physician Referral
  • Locations
    • Springfield
    • Enon
  • Contact Us
    • Leadership

Springfield Orthopaedic & Sports Medicine Institute

Patient Forms

Thank you for selecting Springfield Orthopaedic and Sports Medicine Institute in Springfield and Fairborn, Ohio, for your orthopedic care. To schedule an appointment, please call us at (937) 398-1066 or use our online appointment request form.

Once you have made your initial appointment, you may preregister online by completing the interactive forms below, or you may download and print the forms, fill them out, and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the new patient registration process. 

Interactive Forms:

  • New Patient Registration
  • Health History
  • Prescription Refill
  • Patient Satisfaction Survey
  • Medical Records Release

Downloadable Forms:

  • Image and Video Release
  • OVSH Investor Acknowledgment
  • New Patient Packet
  • Authorization to Treat Minor Patient
  • Medication Allergy Surgery List
  • HIPAA Notice of Privacy Practice
  • Spine Pain Diagram
  • Patient Medical History Intake
  • Patient Notification for OVSH

If you are being seen for a condition related to an upper extremity or lower extremity, please print the correct assessment, fill it out, and bring it with you to your appointment, along with the forms in the New Patient Packet.

  • Upper Extremity Assessment
  • Lower Extremity Assessment

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.

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Locations

Springfield Orthopaedic and Sports Medicine Institute offers two convenient locations in Springfield and Fairborn, Ohio.

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Contact Us

If you have any questions about our orthopedic services, please call our office at (937) 398-1066.

Learn More

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Springfield
140 W. Main Street, Suite 100
Springfield, OH 45502
Monday – Thursday: 8 am – 5 pm
Friday: 8 am – 1 pm

Enon
Dean Medical Center
7774 Dayton-Springfield Road, Suite D
Fairborn, OH 45324
Wednesday: 8am-noon
Thursday: 8am-noon
Closed all other days

(937) 398-1066
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Springfield Orthopaedic and Sports Medicine Institute, with convenient locations in Springfield and Enon, Ohio. Our specialists proudly provide orthopedic services and sports medicine.