To facilitate your experience at The Stone Clinic, we provide these patient forms for you to complete prior to your initial visit. Please complete:

Private Patient Information Record Form (PDF)

Private Patient Information Record Form (Word)

And one of the following forms:

• If you have a neck, shoulder, elbow, wrist, or hand problem, use the Upper Extremity form, either online or by hand.

  Upper Extremity History of Injury (PDF) - [To be printed, then completed by hand].

Upper Extremity History of Injury (Word) - [To be printed, then completed by hand].

• If you have a lower back, hip, knee, ankle, or foot problem, use the Lower Extremity form, either online or by hand.

  Lower Extremity History of Injury (PDF) - [To be printed, then completed by hand].

  Lower Extremity History of Injury (Word) - [To be printed, then completed by hand].

***Please Note*** If you are a patient with a knee problem, please also complete the following three forms, which are used by the Stone Foundation to assess your progress, conduct research, and improve our techniques and methods of treating knee injuries. Thank you.

• 2000 IKDC Subjective Evaluation Knee Form
• Womac
• Tegner Activity Level Scale

We look forward to meeting you and introducing you to the team at The Stone Clinic!

If you have any questions, about these forms or anything else pertaining to your visit, please contact our front desk at reception@stoneclinic.com or (415) 563-3110.