Ortho Care Global

Patient Forms & Documents

Ortho Care Global · International Patient Evaluation

Patient Forms & Documents

Choose the packet that best matches the condition for which you are requesting an evaluation. These PDFs can be completed electronically or printed and filled out legibly.

Select your evaluation packet

Download the form before entering information. For the most reliable results, open it in a PDF application that supports fillable fields; some mobile browsers may not save entered information correctly.

Cervical Spine

For neck and cervical-spine evaluation. Fillable PDF · 18 pages.

Download Cervical Form

Lumbar Spine

For low-back and lumbar-spine evaluation. Fillable PDF · 16 pages.

Download Lumbar Form

Hip Questionnaire

For hip evaluation. Fillable PDF · 16 pages.

Download Hip Form

Knee patients: The current Hip / Knee packet is written primarily for hip history. Please contact Brett before completing it so the appropriate questionnaire can be confirmed.

Imaging checklist

Required medical imaging

All imaging must have been performed within the past six months. Please provide the actual imaging files in DICOM format. Written radiology reports, screenshots, photographs, and standard image files alone are not sufficient for the medical evaluation.

Spine evaluation

For each area of the spine to be evaluated—cervical, thoracic, or lumbar—please provide:

  • A non-contrast MRI
  • AP (front) X-ray
  • Lateral (side) X-ray
  • Flexion X-ray
  • Extension X-ray

Hip or knee evaluation

For each hip or knee to be evaluated, please provide:

  • An MRI of the affected joint
  • X-rays of the affected joint

Additional imaging may be required. Any case-specific requests will be communicated after the initial materials are reviewed.

Preparing files for upload

  1. Locate the DICOM, IMAGES, STUDY, patient-number, or similarly named folder supplied by the imaging center.
  2. Copy the complete folder to your computer. Do not select only the viewer program or radiology report.
  3. Rename the folder using: Full Name – Date of Study – Type of Study – Anatomical Area.
  4. Compress the complete folder into one ZIP file.
  5. Upload the ZIP file through the secure portal below. Upload each separate study as its own clearly named ZIP file.

If you do not have a CD reader or cannot locate the DICOM files, contact Brett before uploading so another submission option can be arranged.

Securely upload your forms and imaging

Use Ortho Care Global’s secure German portal to submit completed questionnaires and ZIP files containing your DICOM imaging. Medical files are not stored on spine-help.com.

Securely Upload Forms & Imaging

This button opens OCG’s GDPR-compliant external upload portal in a new tab.

Before returning your forms

  • Answer every applicable question and save a copy for your records.
  • Gather the imaging reports and other records Brett requests.
  • Do not send completed forms, medical records, or images through ordinary email or SMS.
  • Upload completed questionnaires and ZIP files containing DICOM imaging through the secure OCG portal above.

Email: brett@spine-help.com
Phone: +1 (801) 636-4622
Calls preferred during business hours (Mountain Time). English and Spanish assistance available.