Michael E. Joyce, MD Alex G. Dukas, MD, Christian A. Merrill, MD MBA

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  • Orthopaedics
    • Michael E. Joyce, MD
    • Alex G. Dukas, MD
    • Christian Merrill, MD/MBA
    • Staff
  • Physical Therapy
    • Physical Therapy
    • Staff
  • Injuries by Sport
    • Baseball
    • Basketball
    • Football
    • Gymnastics
    • Soccer
    • Rec./Misc.
  • Patient Education
    • Joint Replacement
    • Shoulder
    • Elbow
    • Hand & Wrist
    • Hip
    • Knee
    • Foot & Ankle
    • Fractures
  • Protocols & Instructions
    • Minimally Invasive Joint Replacement
    • Shoulder Injuries
    • Elbow Injuries
    • Hand & Wrist Injuries
    • Hip Injuries
    • Knee Injuries
    • Ankle Injuries
    • Broken Bones & Sprains
  • More
    • Directions
    • Pay Your Bill
    • Telemedicine
    • Patient Registration
    • Policies & Forms Physical Therapy
    • Policies & Forms Orthopedic
  • Home
  • Orthopaedics
    • Michael E. Joyce, MD
    • Alex G. Dukas, MD
    • Christian Merrill, MD/MBA
    • Staff
  • Physical Therapy
    • Physical Therapy
    • Staff
  • Injuries by Sport
    • Baseball
    • Basketball
    • Football
    • Gymnastics
    • Soccer
    • Rec./Misc.
  • Patient Education
    • Joint Replacement
    • Shoulder
    • Elbow
    • Hand & Wrist
    • Hip
    • Knee
    • Foot & Ankle
    • Fractures
  • Protocols & Instructions
    • Minimally Invasive Joint Replacement
    • Shoulder Injuries
    • Elbow Injuries
    • Hand & Wrist Injuries
    • Hip Injuries
    • Knee Injuries
    • Ankle Injuries
    • Broken Bones & Sprains
  • More
    • Directions
    • Pay Your Bill
    • Telemedicine
    • Patient Registration
    • Policies & Forms Physical Therapy
    • Policies & Forms Orthopedic

patient registration

Please be sure to fill out all Patient Registration Forms on either Desktop or Laptop, Will not be able to submit on mobile device or tablet. Thank You.

Please click here if It is within 24 hours of my appointment to print the forms.

    Patient Registration

    If you do not have an initial appointment at Orthopaedic Sports Specialists, please call our office at 860-652-8883 to schedule one. Do not proceed with this form until you have an appointment. Please complete this form at least 24 hours prior to your scheduled appointment.

    Demographic Information


    Insurance Information

    Some insurances do not provide group numbers. If this is the case for you, just put N/A in the box. *Be sure you are not using the Rx group number*
    This is the name of who the insurance is obtained through (i.e. Spouse, Parent, Self)
    i.e. If the subscriber on the plan is your husband, select spouse.

    Medical History and Information

    Please include full name
    i.e. Dr. John Smith, Cardiology
    i.e. CVS, Walgreens, Stop&Shop, etc.

    History of Injury

    Indicate laterality (i.e. right, left, or bilateral) and which body part (i.e. knee, shoulder, hip, etc.)
    i.e. January 1, 2017 (if acute injury) or 3 months ago (if chronic pain)

    Social History

    Family History

    If your family member has been diagnosed with one of the conditions below, indicate which family member by using the following key:
    M= Mother                                 B=Brother                               MGM= Maternal Grandmother                                     PGM= Paternal Grandmother
    F= Father                                     S= Sister                                    MGF= Maternal Grandfather                                         PGF= Paternal Grandfather
                                                                                                                              O= Other

    Past Medical History

    This section is medical illnesses that YOU have as the patient. This is no longer the Family History section
    i.e. Left knee pain for about a year
    i.e. Left knee ACL reconstruction 1/1/2016

    Medication Information

    i.e. Aspirin, 81mg
    i.e. Vicodin - nausea
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84 Glastonbury Blvd., Suite 101, Glastonbury, CT 06033
​T: (860) 652-8883 F: (860) 652-8887