Patient Forms


We want you to feel comfortable at Capital City Orthopedics. Although your medical care is our primary concern, it is also necessary to address financial issues associated with your care. To help clarify this sometimes complex subject, please note the following policies of Capital City Orthopedics.

Accepted Insurance

We accept most major insurances. Please have your insurance information handy when you call so we can verify we are in network.

New Patient Forms & Office Policies

If you are a new patient then please fill out the New Patient Forms and email it to us before your visit or bring them in. Otherwise, these will need to be completed in the waiting room prior to your appointment.

Please print and sign a copy of the financial policy and bring it with you to your appointment.

If you are an existing patient, you can visit us via the patient portal.

Payment Policies

  • Co-pays, co-insurance, deductibles, and other fees for which you are responsible are due at the time of your appointment.

  • Self-pay services must be paid in full prior to treatment. A reasonable estimate will be provided at this time and any excess amount collected will be refunded.

  • You may make payments by credit card, cash, or check. Returned checks will result in a $25 fee billed to your account.

  • If you require assistance making the necessary payments, please let our staff know as soon as possible to determine if a payment plan can be arranged.

Insurance Policies

  • Your insurance plan is a contract between you and your insurance provider. We will file claims on your behalf for those insurers with whom we contract, assuming you have assigned benefits to your physician.

  • If your insurance provider fails to make payments within a timely period (60 days), payment in full is expected from the patient or responsible party.

  • Failure to respond to an insurer’s request for information can result in claim denial. Should this occur, the account balance will become the immediate responsibility of the patient.

  • Co-insurance and deductibles for procedures are due when the procedure is scheduled.

  • Certain contracts provide for a global period of care associated with certain procedures. Return visits to the physician during this period are provided without charge. Other services provided during the global period, including additional procedures, X-rays, cast/splint changes, braces and medical supplies are associated with additional fees.

  • Evaluation of new or separate problems is not covered by the global period.

  • Fracture treatment may be billed as a procedure and therefore subject to deductibles, co-insurance and a global period in the same manner as surgical treatment.

Medical Records

  • You are entitled to copies of your medical record upon request. A fee of $15 for the first 20 pages and $.50 for each additional page will be assessed to cover document costs.

  • Disability, FMLA, AFLAC and other forms will be completed in a reasonable time period (usually 2 business days.) A $15 fee will be assessed for completion of these documents.

Prescription Refill Policy

  • Prescription refill requests can be made through your pharmacy or by calling the office during regular business hours. Prescription requests made over the weekend will not be reviewed until the next business day.

  • Please avoid calling in requests on Friday afternoon if possible, as they may not be able to be filled before the weekend.

  • Please contact our office staff for any questions or concerns regarding these policies. 


  • X-rays may also be scheduled prior to your appointment date if you would like to save time at your office visit. They can be scheduled at multiple locations in the greater Austin area that may be more convenient for you. These x-rays can be viewed from our office. Copies of the films are not required. Please inquire about this option when making an appointment if you are interested.

Surgical Guides

Rehabilitation Guides, Preoperative Instructions, and Postoperative Instructions.

Learn More →

Capital City Orthopaedics
12201 Renfert Way, Suite 370
Austin, TX 78758
Phone: 512-617-1989
Fax: 512-617-2065
Office Hours

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