To help us provide the highest level of expert pectus care, please complete a few important forms. Read the information on this page then click the link at the bottom of this page. It will take you to our secure HIPAA-compliant patient portal. These forms ensure a smooth intake process. For best results, a desktop computer is preferred over a mobile device for filling-in your forms.
What Information is Needed for Pectus Patient Intake?
The forms include basic patient information such as name, address, and date of birth, along with a brief medical history. Include when the pectus condition was first noticed, if there are any symptoms such as chest pain or shortness of breath.
If available, please upload any notes or reports from doctors who may have evaluated the pectus or any related medical records. Doctor’s notes are helpful but are not required for care.
If imaging is available such as a CT scan, X-ray, or MRI please obtain a copy on disc if possible. This is preferred as it allows our clinical team to review your studies in greater detail prior to your appointment. Imaging is helpful but not required for care.
If available, please upload past photos from vacations, the beach, or swimming at a pool that may show changes in chest shape over time. These photos help illustrate a time-line how the chest condition has progressed over time.
Prepare Ahead of Time
Please gather any relevant information you may have regarding the pectus condition, upload and / or bring it with you to your appointment. This helps our Pectus Care Team be fully prepared for your evaluation and provide expert pectus care. Include any doctor’s notes or reports if available. A prior doctor visit is not required to receive care.
Insurance Information
As a courtesy to our patients, we request a copy of your health insurance card (front and back) to assist with insurance verification. Please upload this as soon as possible, as it may take time to obtain an Estimate of Benefits (EOB) and determine a pre-authorization is required from your insurance company. A prescription is not required for care; however, your insurance company may require one. Our Insurance Department will notify you if needed.
Thank You for Completing Your Information
We look forward to providing personalized, unparalleled pectus care with our nearly 30 years of experience. If you have any questions or need help with the forms, our team is always happy to assist you. Please contact our office at any time.
Click Here to Fill-In Your Forms