Northland Orthopedics Video Visit
Patient information form for patient request for a telemedicine visit
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Name *
Email *
Address *
Phone number *
Have you ever been to Northland Orthopedics before? *
Which physician are you seeing or would like to see? *
What symptoms are you having that brings you in? *
Required
Have you had any imaging?
Our office will call you back within 1 business day to help you select a time for your visit. Submitting this form does not confirm your visit.
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