Over 35 Years of Orthopedic practice in the Texas Medical Center

Bone & Joint Clinic of Houston, For Comprehensive Orthopedic care

6624 Fannin St. 26th Floor
Houston, TX 77030
t: 713.790.1818
Toll Free: 1866.226.3773

Finding the right specialist for your orthopedic needs just got easier

Schedule Your Appointment and Get in Today!

Arthroscopic Rotator Cuff Repair

Rotator Cuff Tears can now be repaired with an all arthroscopic technique using 4 tiny incisions.

Hip and Knee Joint Replacement

Minimal incision and muscle sparing techniques help patients recover more quickly.

Pediatric Orthopedics

Your children deserve a fellowship trained pediatric orthopedist whose entire focus is caring for children and adolescents.

Zimmer’s “Durom” Hip Resurfacing Devices

Zimmer’s Durom Hip Resurfacing Devices referenced in Barry Meier’s article in The New York Times, July 24th Complaints Undermine Hip Device HAVE NEVER BEEN USED by any of our surgeons at Bone & Joint Clinic of Houston. Your Zimmer hip device used by Bone & Joint Clinic of Houston IS NOT the one referenced in the article. The article’s photo does more

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New Patient Form

Please complete the Bone & Joint Clinic of Houston New Patient Form below.

Once the form has been submitted you will receive a confirmation telephone call from our representative. If you don’t receive a call please call our office at 713-790-1818.

Registration

How did you hear about us?*

What is the patient’s first name?*

What is the patient’s last name?*

What is the patient’s date of birth?*

Please enter day/mo/year

What is the patient’s address and zip code?*

Is the patient male or female?*

male

female

What is the patient’s email address?*

What is the patient’s phone number?*

What is the patient’s work phone number?*

Which location would you like to schedule?

All Doctors work out of the Medical Center Facility.

What doctor would you like to schedule with?

If you would like to schedule with one of the following doctors you will have to travel to the Medical Center: Dr. Sherwin Siff, Dr. Roy Smith, Dr. William Waters, Dr. William Granberry

What is the patients martial status?*

Please answer the following if a patient is a minor. If not, please skip to the next section.

Who is the guardian to the patient, first and last name?

What is the above person relationship to the patient?

Does this person have the same address as the patient?

If no:

What is the guardian’s address and zip code?

What is the guardian’s telephone number?

Insurance

Is it an HMO, PPO, or POS?

What is the policy holder’s first and last name?

What is the ID number on the insurance card?

What is the address to mail claims?

What is the telephone number to the insurance company?

What is the relationship of the policy holder to the patient?

What is the group number on the card?

What is the policy holder’s address and zip code?*

What is the policy holder’s date of birth?*

Please enter day/mo/year

Is this a male or female?

Appointment

Please enter an alternative date to schedule an appointment.

What it the telephone you would like us to call you at?

What is the reason for your visit?

Did a physician refer you?

yes

If yes, enter the name of the physician, address, phone #.

When would like to schedule your appointment?

Please enter day/mo/year