Lehigh Valley Orthopedic Institute–Dickson City

Patient Forms

334 Main Street
Dickson City, PA 18519-1668
United States

General Facility Hours
Day Time slot Comment
Mon 8:00 am - 5:00 pm
Tue 8:00 am - 5:00 pm
Wed 8:00 am - 5:00 pm
Thu 8:00 am - 5:00 pm
Fri 8:00 am - 5:00 pm
Sat Closed
Sun Closed
Additional Notes:
See below for Walk-in Injury Center hours and Physical and Occupational Therapy hours.

Patient forms

To save you time when visiting our office, we have conveniently included a list of our patient forms below. Simply download and print the form, complete the questions and bring with you to the office.

Financial Policy
Patient History
Patient Authorization for Release of Information
Notice of Privacy Practices
Spine History Questionnaire (Dr. Gillick, Dr. Henderson)
Rheumatology Questionnaire (Dr. Grady)
Hip Questionnaire (Dr. Schmaltz and Samujh)
Knee Questionnaire (Dr. Schmaltz and Samujh)
Shoulder and Elbow Questionnaire (Dr. Tracy)