Laser Spine Institute Patient Forms

Registration Forms


Complete and return Registration Forms prior to your visit at Laser Spine Institute. Please bring the original copy to your appointment.

Patient Registration Form Download


Patient Authorization to Obtain Medical Information (RIS)


Laser Spine Institute can obtain your MRI records for you. Many imaging providers require that the patient sign a release to provide permission for us to obtain the records. Please sign and return this completed form to your Patient Empowerment Consultant.


Obtaining Medical Records Instructional Download


Permission to Verbally Discuss Health Information


If you would like your family or loved ones to be informed about your health information, you may provide permission with this written form. Please complete and return this form to your Patient Empowerment Consultant or provide verbal permission while speaking with a Laser Spine Institute team member.


Permission to Verbally Discuss Health Info Download


Patient Authorization to Release Medical Information


After your surgery has been completed, you may request your medical records. Please allow a minimum of two weeks from the date of your surgery for your record to be transcribed and completed before sending your request.


Authorization for Release Health Info Download


Patient Authorization to Release Medical Information for Family Medical Leave Act/Short Term Disability ONLY


This release allows Laser Spine Institute to send records for you and help you complete medical leave certification or short-term disability paperwork.


Authorization for Family Medical Leave Act/Short Term Disability ONLY