Forms

NEW PATIENT FORMS:

The New Patient Pack contains a new patient registration form, health history form, privacy policy and others. Please select the Pack that is appropriate for the insurance you are using – if unsure please use the General Patient Pack.

Print and complete all pages prior to your arrival and bring them with you to your visit. This will help speed up the new patient registration process and get you in to see the doctor faster.

General Patient Pack

Workers Comp Pack

Attorney Patient Pack

MEDICAL RECORD REQUEST:

If you are a patient and would like Dr. Rizk to request Records on your behalf, please download and complete the Records Request form and fax to the facility that you would like to send the records to Dr. Rizk. Or you may simply ask for a form at your next visit.

Read More About Medical Record Requests

DENTAL PROCEDURES:

If you have a joint replacement, you will need to let the dentist or hygienist know before you have any dental work done. We ask that you take antibiotics as a preventative action prior to any treatment.

Here is a form you can print and bring with you to your dental appointment so they will know what to prescribe.

Preventative Antibiotic Letter

Meet Our Doctor

RALPH RIZK, DO

Orthopaedic Surgeon

Dr. Ralph Rizk is an Orthopaedic Surgeon who treats both adults and adolescent patients. He practices surgical Orthopaedics, specializing in Adult Hip and Knee Reconstruction Surgery […]

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Dr. Rizk and the staff were very knowledgeable and efficient in evaluating my knee. I feel confident in his ability to help me cope with my aging knee. He had just the right combination of humor and professionalism that made my experience pleasant.