ELOA Documents

(Not available for Dr. Dubiel's patients. Please go back to the Physicians Tab and click on his link)

Registration Form: To complete your Registration Form prior to your appointment, please print out and complete this form and bring it with you to your appointment.

Release of Information Form: According to the policy of East Lansing Orthopedic Association, P.C, a written authorization must be completed for any and all record releases to third parties. Please print this form and return to our office.

Request for Form Completion: In order to have your disability form(s) processed, please print and fill out this form, and return it to our office along with your payment.

New Patient Request Form: Referring physicians, to refer a patient to our office, please print out and complete this form and fax it to (517) 394-4250. Thank you!

HIPAA Notice of Privacy Practices


In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.