Orthopedic & Spine Surgery Patient Forms

Dr. Sameer Mathur and his clinical staff are honored than you have chosen us as your health care provider. Our goal is to provide the highest quality care for all of our patients in a timely and respectful manner.

Please click on the following links below to complete your new patient paperwork prior to your visit. Please complete the forms in their entirety. Once complete, please submit your paperwork online. Please note that if this paperwork is not completed, your appointment may be delayed.

We encourage you to explore the website to learn about all the services that Dr. Mathur offers. We look forward to meeting you at your upcoming appointment. If you have any questions or need to reschedule your appointment, please contact us at 919-297-0000.

New Patient Symptoms and Medical History Form 

New Patient Demographics

Financial Policies and Procedures

Health Disclosure


Please plan to bring the following items with you to your appointment:

  • Government issued photo ID
  • Insurance card
  • Copies of operation records, medical records, x-rays, MRI’s, CT scans, bone scans, and ultrasounds.
  • If you have seen a physical therapist, please bring a progress letter from the therapist.
  • If you have had surgery elsewhere, please bring a copy of your operation report if that is available.
  • A list of all medications that you are currently taking and their doses.
  • A list of known drug allergies and the symptoms you may have from taking these medicines.
  • Your health insurance information.
  • Your claim number if it is a workers compensation injury.