Working in collaboration with local, national, and international facilities, the orthopedic medicine and surgery specialists at REOrthopaedics, Inc., in San Diego have spearheaded numerous scientific investigations that have led to practical treatment solutions bringing immediate benefits to patients and families throughout the world.

INFORMATION FORM - REOrthopaedics, Inc.

Please answer all form questions before submitting.

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Patient Name
Mailing Address
City
State/Zip: /
Phone Number
Date of Birth
Height
Weight
Email Address*

Medical History

Do you or have you ever had any of the following?

Rheumatic Fever: Yes; No
Heart Trouble: Yes; No
Chest Pains: Yes; No
Shortness of Breath: Yes; No
Swelling of the Ankles: Yes; No
High Blood Pressure: Yes; No
Chronic Lung Problems: Yes; No
Diabetes: Yes; No
Cancer: Yes; No
Radiation Therapy: Yes; No
Kidney Problems: Yes; No
Hepatitis: Yes; No
Thyroid Problems: Yes; No
Asthma: Yes; No
Anemia: Yes; No
Blood Disorders: Yes; No
Skin Disorders: Yes; No

Any other serious illness (HIV, multiple infections, etc.)? If yes, please list:
How did you learn about our center?
The name of the medical condition for which you are seeking information
A short medical history about this condition, including its origin and treatment history
The name of a physician familiar with your condition

Other hospitalizations and/or previous surgery: Please list with dates (if you know them):
Allergies: Are you allergic to or have you ever had a reaction to any medication, drug or local anesthetic? Please list:
Medications: Are you now or have you ever taken any medications on a regular basis (aspirin, birth control pills, vitamins included)? Please list:

7910 Frost Street, Suite 120
San Diego, California 92123
Google Map & Driving Directions

Phone: (858) 300-0487

Fax: (858) 300-0484