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Patient Registration Forms

USA conveniently provides access to our registration forms online. You can help expedite your appointment by completing and submitting your forms online at least one day prior to your appointment. Follow the directions below.

1. Download

Click on the name of the form you would like to download. Please note, Adobe Reader or Acrobat is needed to view and complete the form. If you need to download Adobe Reader click here.

Patient Registration Form for adult patients

Child Registration Form for child patients

Prosthetic Registration Form for prosthetics patients

2. Complete & Save

Complete the form by filling in the blue boxes then save it by selecting "File" in the top left corner then "Save" or by hitting the save icon in the top left corner (see example below.) Another window will pop up — the name of the file is highlighted at the bottom. You may leave it named as is or type in a new name. You may also select where to save the file (desktop, documents folder, etc.)


3. Send the Form

3. Click here or type in your browser and click the "Submit Registration Information" button

4. Type the patient's first and last name in the provided boxes.

5. Click on the "Browse" button and another window should pop up on your screen, allowing you to search for the form. Select the form that you completed and saved (see example below.)

(Once you select the file you may have to click "ok" or "open" then the pop up window will disappear.) Check to see that the name of your form appears in the area beside the "Browse" button (as in the example below).

If the form you are submitting is an adult patient form, click the Submit button. If it is child or prosthetic patient form, select either one from the drop-down menu to the right (the arrow pointing down beside the box labeled Patient Form) then click the Submit button.

If you have questions please call (423) 267-0466.