Patient Resources



You’ll need the following information:

  • Your Name
  • Date of Birth
  • Brief description of the reason for the appointment
  • Your Address
  • Phone Numbers
  • Primary physician or health care provider
  • Insurance Information


Save time by completing your forms before your visit. Please print out our patient form packet below.

New Patient Packet

NOTE: Please do not mail your paperwork, bring it with you to your appointment.

Authority for Release of Health Information


Complete all appropriate forms for the physician you will be seeing before your visit, if possible.

Please bring the following items to every visit:

  • Driver’s License/Other Valid Government-Issued Photo ID
  • Insurance Card and any co-payment due for the visit
  • Referral forms, if applicable
  • X-rays and any related studies, if applicable
  • Any necessary new patient or follow-up forms

NOTE: If this is your first visit with us, please review the New Patient information to be better prepared for your visit.


Help your physician diagnose and treat your condition by being prepared to answer the following questions:

  • What are your main symptoms?
  • How long have you had your symptoms?
  • What were you doing when your symptoms started?
  • Have you had this problem in the past?
  • What was the diagnosis?
  • How was it treated?
  • How and when did an injury occur? How was it treated?
  • Have you had any injuries in the past to the same area? Do you have any continuing problems because of the previous injury?
  • Have you ever had surgery in that area?
  • What activities, related to sports, work, or your lifestyle, make your symptoms better or worse?
  • Do you think that activities related to your job or hobbies caused your symptoms?
  • What home treatment measures have you tried? Did they help?
  • What nonprescription medicines have you taken? Did they help?
  • Make a list to avoid forgetting any specifics.


Please arrive for your scheduled appointment on time. We recommend that new patients arrive 20 minutes early to fill out any necessary paperwork. Patients who arrive more than 15 minutes after their scheduled time may need to be rescheduled.

All of our physicians and therapists at 417 Sports Medicine and Orthopedics believe strongly in the importance of every patient keeping their appointments. When patients fail to keep their scheduled appointment, they miss out on crucial medical information regarding their recovery.

Please be advised that we require no less than a 24-hour notice whenever an office/physical therapy appointment is cancelled.

  • If you have an appointment on a Monday before 12:00 pm, you must call before 12:00 pm on Friday before your scheduled appointment if you will be billed a No-Show fee.
  • Insurance plans are not responsible for No-Show Fee’s: it is the responsibility of the patient to pay the bill upon receipt.
  • If you need to cancel an appointment and it is after hours or during the weekend, you may leave a message with our answering service. We recommend that you make a note of the name of the service operator/receptionist whenever you call to cancel or reschedule an appointment.


417 Sports Medicine & Orthopedics
3328 South National Avenue
Springfield, MO 65807
Phone: 417-261-5669
Fax: 417-771-3256

Office Hours

Get in touch