Patient Forms

New Patient Forms

Once you have made your initial appointment at Belleview Orthopedic Center in Florida, you can pre-register by clicking on the links for New Patient Forms below.  Please download, print, and complete the forms prior to your arrival.  Upon arriving at our orthopedic office, simply check in with our receptionist and provide her with your paperwork. 

• New Patient Packet (PDF)

If you are an existing patient and need to update your forms, please download, print, and complete any of the following forms below and bring or send them to our office:

• Notice of Privacy Practices: Consent Form
• Financial Policy: Consent Form
• Release of Medical Information
• HIPAA Policy

Physician Referral

Thank you for referring your patient to Belleview Orthopedic Center in Belleview, Florida.  Our Board-Certified Fellowship-Trained Orthopedic Surgeons, David B. Ethier, MD and James C. Seymore, MD have expertise in general orthopedics, joint replacement, and sports medicine.  We offer Same Day Appointments.  Please call our office at (352) 307-7678 to discuss a patient referral or download, complete, and fax our Patient Referral Form to Fax (352) 307-7677.

• Physician Referral Form (PDF)

Please note:  It may take a few minutes to load the forms if you are using a dial-up 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.