Forms and Policies
Forms & Policies Overview
Below you will find explanations for, and links to our patient forms.
These forms can either be filled-out online, or printed.
Form Overview
This is a basic form stating that you fully understand and agree to the services of Summit Orthopedic Home Care. You will also be prompted to share your insurance information with us.
Form Overview
This form simply requests that you either have received Summit Orthopedic Home Care's Notice of Privacy Practices, or that you do not wish to receive a copy.
Form Overview
With this form we seek confirmation of your understanding that Summit Orthopedic Home Care services require face-to-face interaction between the patient and physician.
Form Overview
If you are not covered by Medicare, you will need to fill out this form acknowledging that Medicare will not be responsible for the coverage of Summit Orthopedic Home Care services.
Contact Us Today
Let us show you how good your home care or hospice experience can be. Call us and let your physician and hospital discharge planner know that you choose Summit Home Care!