Patient Forms

//Patient Forms

New Patients

We are eager to make a convenient appointment for you.

At Nashville Hip Institute, our goal is to make sure that we have all the information to make your visit optimally productive for you. Many patients come from out of town—we help them by scheduling visits with each of the providers who do tests and assessments in one day. And, we review the records and all the information you send to make sure we can address your particular case.

Completed forms mean your electronic health record is ready to go when you arrive. You’ll eliminate the 30 minutes in the reception room and be seen as close to your actual appointment time as possible. In order to accomplish this, we must receive your forms three days prior to your appointment.

We look forward to contributing to the resolution of your hip pain.

Thank you for helping us help you!

Your NHI Team

New Patient Instructions

Why Do We Require Your Forms 3-Days Before Your Appointment?

Because we don’t want to waste your time or your money.

Your completed forms allow us to verify your insurance benefits in detail and set up your chart in the electronic medical record.  By reviewing your medical records very thoroughly before your appointment, we can make sure that our clinical expertise can address your problem.  If it cannot, we will call and cancel your appointment or refer you to another colleague.

Patient Packet Download and Due Dates

  • Download and complete the NEW PATIENT PACKET.
  • Due date for delivery of forms to our office:
    • Monday appointment – return forms by Wednesday of previous week.
    • Tuesday appointment – return forms by Thursday of previous week.
    • Wednesday appointment – return forms by Friday of previous week.
    • Thursday appointment – return forms by Monday of same week.
    • Friday appointment – return forms by by Tuesday of same week.
  • Do NOT send forms in on your appointment day.
  • If we do not receive your completed forms by the deadline, your appointment will be cancelled.

Sending Instructions for New Patient Packet

The new patient packet must be received three days prior to your appointment and can be submitted to our office by email, fax, regular mail, or hand-delivered.

Please contact Morgan Bivens at 615-760-0889 with any questions regarding the completion of the forms.

Email

morgan@nashvillehip.org

Fax

(615) 284-5819

Mailing and Physical Address

Nashville Hip Institute
2004 Hayes Street
Suite 700
Nashville, TN  37203
Attn:  Morgan Bivens

ALL FORMS

(Click on links to download)

NEW PATIENT PACKET

New patients must download and complete the entire new patient packet.

Please download and submit the below individual forms only if you have been directed to do so by our staff.

Patient Satisfaction Survey

Patient Health History

Authorization to Release Medical Information

Form for Referring Providers

Hip Arthroscopy – Pre-Operative Insurance Information

Notice of Privacy Practices

Modified Harris Hip Evaluation Form

International Hip Outcome Tool (IHOT12)

Face Sheet

Patient Financial Policy