Hess Orthopaedics & Sports Medicine, PLC 

4165 Quarles Court • Harrisonburg, Virginia  22801 •540-434-1664 (phone) • 540-433-5931 (fax) •

540-437-7585 (rehab phone) • 540-437-7592 (rehab fax)

Thank you for choosing Hess Orthopaedics for your healthcare needs. 

Before you are treated by one of our providers, you will be asked to give us some information.  

Please fill out the following forms and bring them with you to your first visit:

Patient Demographic Form

History of Present Illness Form 

Medical History Form

IMPORTANT NOTES: 

• You will be asked to present your  insurance card(s) at each visit.  This is to ensure that we file your medical claims to the appropriate insurance company.   

• All patients are responsible for getting a referral to our office from their insurance company and/or primary care physician (if required). 

• Please contact your insurance company before your first visit, to ensure that we participate with your insurer and that you will not be totally responsible for your account balance. 

• You will be responsible for paying all co-payments on the date of service.  

 CLICK HERE FOR A COPY OF OUR PATIENT CONFIDENTIALITY POLICY

CLICK HERE FOR A COPY OF OUR PRACTICE BROCHURE 

CLICK HERE FOR EVEN MORE INFORMATION ABOUT OUR PRACTICE