Forms
Worker's Compensation Injury Form
Please complete this form if you are being seen by an AOC physician for a Workman's Compensation Injury.
Spine Form
Please ONLY complete this form if you are being seen by Dr. Revels or Dr. Donahoe for a back or neck related problem.
HIPAA
All patients being seen at AOC must sign this form. (Please contact our office for an alternate HIPAA form.)
Medicaid
Please complete this form if you are being seen by an AOC physician and you are covered under Medicaid.
Account Agreement Form
Please complete this form if you are being seen by an AOC physician as Private Pay (non-insured) or are covered under insurance other than Medicare or Medicaid.
Medicare Authorization Form
Please complete this form if you are being seen by an AOC physician and you are covered under Medicare.
Non-Covered Care For Blue Cross Blue Shield
Please complete this form if you are being seen by an AOC physician and you are covered by Blue Cross and Blue Shield
Medical History Form
Please complete this form if you are being seen by an AOC physician for any injury or problem other than seeing Dr. Revels for your neck or back.
Release Form
Please complete this form if you are requesting a copy of your medical records to be sent to yourself or to a third party. Print, complete the form, sign and then fax or mail to the address at the top of the form.
