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Forms

J & J Artificial Limb and Brace knows how precious time is therefore to save you time we have provided patient information forms that you may print, complete and bring to your first office appointment. Be sure to also bring the following:

  • A prescription from your physician or your child's physician
  • Health insurance card
  • Old orthotic/prosthetic devices (if replacing them)

If you are unable to keep your appointment please contact our office within 24 hours in advance.

Patient Information forms in English

Notice of Privacy Practices

Acknowledgement of Receipt of Notice of Privacy Practices

Authorization for Use of Protected Health Information

Patient/Client Bill of Rights

Facesheet

 

Patient Information forms in Spanish

Spanish Information Forms

 

Hart Orthotic System Measurement Forms

To help expedite the process of obtaining a Hart Orthotic System for your child please print out the measurement forms below and have your child's Physical Therapist complete them. Please have your Physical Therapist fax these forms to (858)613-0959 one week prior to your initial demo Hart Orthotic System appointment.

Hart Orthotic Measurement Form

Hart Orthotic Foot Measurement Form

 

Brochure

J & J Artificial Limb and Brace Brochure