Medical Forms & Surveys

Medical Forms & Surveys

For all forms, please fill in all of the items as completely as possible by printing clearly in black or blue ink. Bring the completed forms with you and present them when you check-in for your appointment.

Please have your most current insurance card and picture identification with you. If you have a copay then you will provide that at the time of your visit.

For Release of Medical Records

Baton Rouge Orthopaedic Clinic works with ScanSTAT for medical records services. In order to obtain a copy of your medical records, you may either visit our clinic on Bluebonnet any time between 8AM to 4PM Monday through Friday, or you can download and complete the form below and either fax to (225) 478-0695 or you can email your request to

When a return fax number is provided on the request, ScanSTAT sends an automatic fax notification within 24 hours to confirm receipt.

Requests are processed within 10 business days following receipt of request by ScanSTAT staff, prioritized by request type and regulatory requirements.  Once processed, an invoice is sent by the requester’s preferred method (indicated on the request), and records are immediately available for download upon invoice payment.

 ** Providing an email address for invoice delivery will speed the process and avoid postal mail delays.

If you need additional information or have questions regarding the status of your release of medical records please call Resolve ROI directly at (225) 408-7807 or email

How Can We Help?

Our highly skilled physicians utilize advanced technology and state of the art medical equipment and techniques to enhance the healing process.