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Patient Forms

Please click on the documents below to prepare for your upcoming appointment or surgery.

Pre-Operative Medical History

If you are having surgery at our in-house Ambulatory Surgery Center (ASC) please download and complete these forms. Fax to: 630-443-2063


Back & Neck Questionnaire

Fill out this form and bring it in for your appointment with Dr. Siodlarz


Health History Form

Please print this form, fill it out, and bring it in with you for your appointment.


Request Your Medical Records

Use this form to request medical records. Please note that some records may require a fee. Once completed, fax to: 630-584-1733 or drop it off at one of our three locations.


Disability / FMLA Forms

If you would like to request the completion of a Disability form or FMLA form, please complete this authorization form, including the fee and drop it off at one of our three locations, or mail to:
ATTN: Medical Records Department
2525 Kaneville Road, Geneva, IL, 60134


MRI Minor Authorization Form

This is for patients who are 17 years or younger and coming with someone other than a parent, please complete this form and fax to 630-938-4013


Prevention Program...Register Today!

Whether you are a seasoned athlete or weekend warrior, sports injuries can often be prevented or reduced by following a few simple precautions. Learn firsthand how to reduce your risk of acute injuries (sprains, strains, fractures, and dislocations) and overuse injuries (tendinitis, stress fractures, swimmer’s shoulder, runner’s/jumper’s knee, and shin splints). In addition, learn how single sports specialization, as a young athlete, can lead to overuse injury and burnout. The program will cover specific physical therapy prevention techniques and healthy lifestyle tips. This program is presented by orthopedic surgeon and team doctor for the Kane County Cougars, Dr. James Sostak of Fox Valley Orthopedics.

Click Here to Register
Oh My Aching Feet -- Arthritis
in the Feet & Ankles

Arthritis in your feet can affect your every move as inflammation and swelling of the joints become increasingly more difficult. Fox Valley Orthopedic Foot and Ankle Surgeon Dr. Eric Bartel will discuss arthritis on the lower extremities and ankles, and how to prevent, treat and even live with arthritis. Biological infusion therapy will also be discussed, and well as using mobility aids.

Click Here to Register