Forms

New Patient Forms

New patients: please download and print all five (5) pages. Please complete and bring with you to your appointment.

New Patient Forms (633 KB)

Sponsorship and Advertisement Request Forms

Lemak Sports Medicine & Orthopedics considers all sponsorship and advertisement requests. Upon review, our marketing department will contact you if we are interested in your request.

LSM Advertisement Request Form (309 KB)
LSM Sponsorship Request Form (308 KB)

Patient Referral Form

To submit your referral request please complete the Patient Referral Form and fax to the appropriate clinic, along with any relevant patient clinical information and a copy of the patient’s insurance card. If you have any MRI or X-ray information, please provide or instruct your patient to bring to their appointment.

LSM Referral Form (39 KB)