standard-title Dr. Mikulak Forms

Dr. Mikulak Forms

Coming To See Dr. Mikulak and Physician’s Assistant: Michael Walker, MS, PA-C

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Download, Print, and Complete These Forms Prior To Your First Visit…

1) Patient Information Form

2) Medical Information Release Form (HIPAA)

3) Patient Financial Agreement

4) Initial Visit History – Lower Extremity

4) Initial Visit History – Upper Extremity

5) Patient/Physician Contract

6) No Show Policy

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