OSMI at Daybreak

The Official Team Physicians of the Florida Gators and the Santa Fe Saints

Patient Forms

Patient Forms

To establish e-mail interactions with your provider, please read and complete the "Authorization to use or disclose Protected Health Information via electronic media" form. Please bring the completed authorization with you to your next clinic visit. Download Authorization Form (.pdf)

To help us provide you with better care, please download and print the questionnaire. Please bring the completed questionnaire with you to your appointment. Thank you.

 

Patient Forms and Questionnaires

Medical History for Physician Appointments

Please bring a completed copy of each of the forms below to your first physician appointment - located on the 2nd floor of the Institute.

 

OSMI New Patient Medical History Questionnaire
Download Form (.pdf)

 

OSMI SpineCare Center:
New Patient History Questionnaire
For Physical Medicine and Rehabilitation Patients patients ONLY: Download Form (.pdf)

 

Physical Therapy (Shands)

Please bring a completed copy of each of the forms below to your first Shands Physical Therapy appointment – located on the 1st floor of the Institute.


Medical History Questionnaire:
Download Form (.pdf)

Health Survey: Download Form (.pdf)

Attendance Policy: Download Form (.pdf)


Functionality Questionnaire (Choose the one that matches the location of your injury)

 

UF Medical Record Release

Our goal is to provide you with excellent customer service. All request for medical records can take up to 10-15 business days for processing. To help avoid unnecessary delays, please fill out the request for records in its entirety. If you have any questions when filling out this form please do not hesitate to call us.

 

Please return the completed Medical Record Release Form (found below) via our fax number or to the mailing address below:

 

UF Orthopaedics and Sports Medicine Institute
ATTENTION: Medical Records
Fax: 352.273.7294
Address: P.O. Box 112733
Gainesville, Florida 32611

 

Medical Record Release Form:
Download Form (.pdf)

 

Thank you for your assistance and cooperation.

 

UF Orthopaedic Clinic
Medical Records Staff
Phone: 352.273.7061

 

Visitor Forms

Observing at The Orthopaedics Institute
Observation Tour Form: Download Form (.pdf)

 

OSMI Confidentiality Statement
Confidentiality Form: Download Form (.pdf)

 

Patient Referrals: Consultation Forms

Consultation Request - Referring Physicians
Consultation Request: Download Form (.pdf)

 

Address & Location

OSMI Mailing Address:

UF&Shands Orthopaedics and
Sports Medicine Institute
PO Box 112727
Gainesville, FL 32611

Located at:

3450 Hull Road

Gainesville, FL 32607

Directions | Google Map

Parking | Building Directory

To Make an Appointment:
352.273.7001 | 877.4UF.Ortho
Fax: 352.273.7293

Get an E-Appointment

Contact Us