Forms

Thank you for making your appointment with Lake Orthopaedic Associates, Inc. We look forward to seeing you. To help us accommodate your needs, please review the checklist to the right. In addition, please verify with your Insurance Company that we are on your plan. Patients who are not covered by health insurance will be required to pay for services as they are rendered. Payment arrangements can be made. We accept cash, check, Discover, Master Card and Visa. If the patient is under age of 18 years, a parent/guardian must accompany the patient. If the parent/guardian can not be present, a note of permission must be presented with the patient before they can be treated.

Please let us know if we can assist you in anyway

Willoughby: 440-942-1050
Mentor: 440-352-1711

Please bring the following to your appointment Appointment Check List

The Downloadable forms provided in advance to make your appointment more carefree. Fill in and Print from your computer OR print out and fill in by hand.

Your insurance card(s) along with your co-pay which is due at time of visit.

  • We accept American Express

Referral if necessary

Drivers license or photo ID

Any tests you have had regarding your problem for example EMG or lab results

Any X-ray files including MRI, C.T. scan, etc. along with the reports

Any other information that may help our physician(s)

For Workers Compensation Patients:

  • B.W.C. Card with your MCO information
  • C-9 if needed
  • Employer information (name & phone number of contact person)

Please hand carry all this information with you to your appointment. Do not mail.

If you are unable to bring all of the information listed above, please call so that we may reschedule your appointment.