Midlothian Medical & Sports Center
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INFORMATION FOR NEW PATIENTS

What to Expect
At Midlothian Medical and Sports Center, the initial visit is a diagnostic appointment designed to determine if we can assist you with your injury. During this visit, we will gather X-rays and perform an orthopedic exam. Our medical team will then convene to discuss your case. We do not initiate treatment on the first visit, as it is solely for diagnosis and to determine if you are a candidate for treatment. If you are eligible, treatment can begin as early as the second appointment, with a personalized treatment plan created by our medical team to address your injury and alleviate your pain.

New Patient Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Peripheral Neuropathy treatment
patient intake form

ONLINE FORMS

Midlothian Medical & Sports Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click to the below button to download the form.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.
Patient Consent form
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THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT. FL Statute 456.062
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