As we all know, sometimes doctor visits require necessary paperwork. To make it more convenient for you, you may download our required forms, print them, and fill them out prior to your appointment. Capital Region Orthopaedics complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Capital Region Ambulatory Surgery Center, LLC, complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex

Along with your completed paperwork, please bring the following with you to your scheduled appointment:

  • Insurance card
  • Photo ID
  • Referrals (if required)
  • Co-payments

For MRI scans, wear loose-fitting clothing (no metals).

New Patient Forms

Medical History Form (PDF) Patient Check-In Form (PDF)

Ambulatory Surgery Center Forms

Pre-Admission Testing Prior to Surgery FormHealth Care Proxy (PDF)Patient Satisfaction Survey (PDF)

After your surgery, please complete the Patient Satisfaction Survey and send to: 

Capital Region Ambulatory Surgery Center
1367 Washington Avenue, Suite 401 
Albany, NY 12206

Medical Records Requests

To obtain copies of medical records, please fill out the Patient Health Information Release Authorization Form and submit by fax to 518-935-4195, by mail to the attention of CIOX Health, or drop off in person at any of our office locations.

Mailing Address
Attn: Ciox Health
Capital Region Orthopaedics
1367 Washington Avenue, Suite 200
Albany, NY 12206

To contact Ciox Health regarding the status of your request, please call 518-935-4167.

The latest version of Adobe Acrobat Reader is required to view and print PDF files, and it is available here 

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