DR. JUREK

NEW PATIENTS

Dr. Jurek is a board-certified orthopaedic surgeon specializing in shoulder surgery as well as sports medicine.  She has focused fellowship training in both specialities.

More about Dr. Jurek

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​NEW PATIENT INSTRUCTIONS AND FORMS
I want you to get the most out of your appointment with me. In order to accomplish this, it may be helpful to review your condition or injury on my website and write down any questions you may have.  I want to perform a thorough evaluation and ask that you complete all forms in their entirety and review the information below on what to bring to your appointment.

For your convenience, the new patient forms are available in PDF format at the bottom of this page for you to complete prior to your appointment. If you complete them online, please print them from your printer and bring them with you for your visit.

What to bring to your appointment:

• Any X-rays, MRI scans, or other diagnostic tests related to your condition or injury. Please bring the actual X-rays/scans in addition to the reports. CD format is preferred.
• Operative reports of your previous surgeries for the condition or injury for which you are being seen (this is commonly called an "op note."  It is a part of your medical record and can be requested from your previous surgeon's office).
• Any notes of previous evaluations for the condition or injury for which you are being seen.
• Please bring or wear shorts for evaluation of a lower extremity condition or injury (i.e. knee injury).
• For female patients, please bring or wear a tanktop or sleeveless shirt for a shoulder evaluation.
• Your completed forms if you have chosen to fill them out prior to your visit.  Please complete the appropriate injury evaluation form that is applicable to your specific injury/complaint.

PRINTABLE NEW PATIENT FORMS
Patient Medical History
Patient Registration
Patient Health Information Authorization
Financial Policy
Notice of Privacy Practices (for review only; does not need to be printed)
Acknowledgement of Notice of Privacy Practices
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ADDITIONAL PRINTABLE FORMS
​MRI Procedure Screening Form
Medical Records Request Form
Consent to Treat a Minor
Motor Vehicle Accident & Personal Injury Billing Policy
Seattle Surgery Center Handbook
Swedish Orthopedic Institute Surgery Guide