Dr. Mikulak Forms
Download, Print, and Complete These Forms Prior To Your First Visit…
2) Medical Information Release Form (HIPAA)
3) Patient Financial Agreement
4) Initial Visit History – Lower Extremity
4) Initial Visit History – Upper Extremity
Remember to bring the following items:
- X-ray, MRI, EMG or other studies
- Operative reports
- Diagnostic test results
- Insurance information
- Current list of medications
- Photo identification