Forms
NEW PATIENT FORMS:
The New Patient Pack contains a new patient registration form, health history form, privacy policy and others. Please select the Pack that is appropriate for the body part you are being seen for. If yours is not listed, select the General Patient Pack.
Print and complete all pages prior to your arrival and bring them with you to your visit. This will help speed up the new patient registration process and get you in to see the doctor faster.
MEDICAL RECORD REQUEST:
If you are patient and would like Heekin Clinic to request Records on your behalf, please download and complete the Records Request form and fax to the facility that you would like to send the records to Heekin Clinic. Or you may simply ask for a form at your next visit.
DENTAL PROCEDURES:
If you have a joint replacement, you will need to let the dentist or hygienist know before you have any dental work done. We ask that you take antibiotics as a preventative action prior to any treatment.
Here is a form you can print and bring with you to your dental appointment so they will know what to prescribe.
Meet Our Doctor
RALPH RIZK, DO
Orthopaedic Surgeon
Dr. Ralph Rizk is an Orthopaedic Surgeon who treats both adults and adolescent patients. He practices surgical Orthopaedics, specializing in Adult Hip and Knee Reconstruction Surgery […]
Judith Vlasic
PATIENT OF THE HEEKIN CLINIC
Better Health Care is Our Mission
Flexible scheduling and same-day appointments available!