Patient Forms


About Your Appointment

If you are a new patient with our office, please arrive 15 minutes earlier to allow time to complete your paperwork. Or you can take advantage of the convenient on-line patient forms below, complete and print at your leisure at home prior to arriving for your appointment.

Patient Forms

New Patient Registration Form

Physical Therapy New Patient Package

Medical Records Release Form

Appointments with John S. Hruska, MD & Emily H. Putney, DO:

New Patient Registration Form for Back Appointments

Surgery Cancellation Policy:

Coastal Orthopaedic & Sports Medicine Center has implemented a surgery cancellation policy for patients cancelling less than 48 hours prior to their surgical procedure.

Due to limited time spots for surgery, we request patients cancel surgery at least 48 hours before their scheduled procedures.  This gives Coastal Orthopaedic & Sports Medicine Center the opportunity to fill the time slot for the physician as there are numerous patients waiting for surgery.  A patient may cancel by phone and will need to speak to our surgical coordinator or come to the office in person.  If you need to cancel your surgery, Coastal Orthopaedic & Sports Medicine Center will refund your account when the procedure is cancelled prior to 48 hours of its scheduled date.  However, any surgical procedures not cancelled prior to the 48 hours will incur a fee of $200.00 which will be deducted from the surgery deposit.  If no deposit is required, Coastal will bill the cancellation fee of $200.00 to the patient.

**Only an emergency constitutes a cancellation less than 48 hours prior to procedures.  This will be discussed between the patient and the physician.

Patient Portal:

In our ongoing efforts to improve the quality and efficiency of care to our patients, Coastal Orthopaedic & Sports Medicine Center is implementing a new way to communicate with our practice online. The Patient Portal is a secure, web-based system that will allow real time access to your medical records and our staff. Patients will be able to:

  • Ask the Medical Team (MA’s, Surgical Schedulers)questions
  • Ask the Referral Coordinator and Billing Department questions
  • Request an appointment
  • Request prescription refill
  • Pay your bill online
  • Add or update your records

The two-way secure messaging allows you to contact our office electronically, and also allow our staff to communicate with you. Coastal Orthopaedic & Sports Medicine Center will still remain available to you by phone during normal business hours. Using the patient portal will allow you to bypass voicemails and telephone systems. You can communicate with our staff at your convenience, during business hours (Monday thru Friday 8:30am to 5:00pm), from any device which includes cell phones with internet access.


When you connect to the portal, you are NOT connecting to our actual office computer system, but a secure web site hosted elsewhere. Only the limited information you see is stored on the portal. Patient records are maintained in our office.

To use the patient portal, you must first provide the office with a permanent email address which you use and check regularly. Once this has been provided, you will receive an invitation email to create your portal account. You will receive 3 invitations in total and will have 10 days to create a portal account, if you do not create a portal account after the 3 invitations, you will not receive more invites and will not be able to create a portal account. Private health information will not be sent to your email; you will receive alerts through your email when new information is posted to the patient portal.

In an effort to maintain your information secure and confidential, the system will lock you out after 5 failed log-in attempts. To avoid being locked out, please use and click on Forgot password/User Name and you will be prompted to reset your account password.

If for any reason you decide that you will not use the patient portal after you register, please inform the office so that your account can be deactivated.

Important Information Regarding the Patient Portal

  • For Non-Emergency communication and Requests only
  • Please allow up to 24-48 business hours for us to respond.
  • Please allow up to 24-48 business hours for prescriptions refills.
  • Coastal Orthopaedic & Sports Medicine Center will not send any private health information to your e-mail.


The Coastal Orthopaedic & Sports Medicine Center Wireless Guest Internet Access is provided solely for the use of official Coastal Orthopaedic & Sports Medicine Center guests, Coastal Orthopaedic & Sports Medicine Center patients, patient’s families, and patient’s guests. Any other use is unauthorized.

View Policy Here

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