Northland Orthopedics Video Visit
Patient information form for patient request for a telemedicine visit
Have you ever been to Northland Orthopedics before?
Which physician are you seeing or would like to see?
Dr. Steven Smith
Dr. Vivek Agrawal
Dr. Dustin Woyski
No preference, please use my symptoms to decide who is appropriate
What symptoms are you having that brings you in?
Joint pain (please indicate side and which joint in "other" tab)
Painful joint replacement
Need joint replacement
Trauma or fracture
Have you had any imaging?
Yes, but unsure what it was
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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