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MAKOplasty®
Hip Resurfacing
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Anterior Hip Replacement
Joint Replacement
For Appointments Please Call 713-827-9316

Forms

Provided below are various forms that require completion prior to your visit and/or surgery. Please download the appropriate form as directed by your physician and/or staff by clicking on the name of the form. If you cannot access the form, please click on the Adobe box. This will allow you to download this software, providing access to the forms. Please bring the completed form(s) with you to your scheduled visit. This will help expedite the registration process. Thank you.

Patient Information Form Patient Information Form
Financial Policy Statement Release of Health Information
Financial Policy Statement Medical Release
Financial Policy Statement Financial Policy Statement
Lifetime Beneficiary Claim Authrization Lifetime Beneficiary Claim Authorization
Notice of Privacy Practices Notice of Privacy Practices

If you cannot access the forms you can click on the icon to download the software.

Download Acrobat

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