[fusion_builder_container hundred_percent=”yes” overflow=”visible” type=”legacy”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_1″ last=”true” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_color=”” border_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=”” min_height=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” first=”true”][fusion_text]

Reminder On Submissions

  • Please remember upon completion of your form, only hit the “request/submit button” once. Hitting the submission button more than once can cause issues in regards to your submitted data.
  • Many of you take advantage of the upload feature that allows you to submit photo identification, insurance cards, and medical records. These files take time to upload to the server. The speed depends on your internet connection and the size of the file. Please allow the files to upload before form submission.
  • Upon submission of your form you should receive an confirmation of submission. All confirmations are sent from the server at the time of your submission. However, please allow up to 60 minutes for receipt of confirmation. If you do not receive a confirmation in that time please check your spam folder. If it is not there, then contact our office. Email is like “snail mail” at times. Delivery can be affected by many things such as; email traffic on your own server or spam filters on your own server.

[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ layout=”1_1″ background_position=”left top” background_color=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none” last=”true” hover_type=”none” link=”” border_position=”all” align_self=”flex-start” border_sizes_top=”” border_sizes_bottom=”” border_sizes_left=”” border_sizes_right=”” first=”true”][fusion_button link=”/vs-surgery-schedule” color=”custom” size=”” stretch=”yes” type=”” target=”_self” title=”View Surgery Schedule” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” bevel_color=”” icon=”” icon_position=”left” icon_divider=”no” modal=”” animation_type=”0″ animation_direction=”left” animation_speed=”1″ animation_offset=”” alignment=”” class=”” id=””]View Surgery Schedule[/fusion_button][/fusion_builder_column][fusion_builder_column type=”1_1″ layout=”1_1″ last=”true” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_color=”” border_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=”” min_height=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” first=”true”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”” rule_size=”” rule_color=”” hue=”” saturation=”” lightness=”” alpha=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” font_size=”” line_height=”” letter_spacing=”” text_transform=”” text_color=”” animation_type=”” animation_direction=”left” animation_color=”” animation_speed=”0.3″ animation_delay=”0″ animation_offset=””]

Medical Records Upload Trial

  • You are now able to upload Medical Records to the server. You can do so by clicking the button below. You will also see a button on the right hand side of the various surgical scheduling forms.
  • There is a 24MB file upload limit.
  • Please be patient during the upload process. Upload times will vary depending on the size of the file, and your internet connection. Please refrain from hitting the submission button more than once. You will be notified when the upload has completed successfully.

[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ layout=”1_1″ background_position=”left top” background_color=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none” last=”true” hover_type=”none” link=”” border_position=”all” align_self=”flex-start” border_sizes_top=”” border_sizes_bottom=”” border_sizes_left=”” border_sizes_right=”” first=”true”][fusion_button link=”/medical-records-upload” title=”Upload Medical Records” target=”_self” alignment=”” modal=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” color=”custom” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” type=”” bevel_color=”” size=”” stretch=”yes” icon=”” icon_position=”left” icon_divider=”no” animation_type=”” animation_direction=”left” animation_speed=”1.0″ animation_offset=””]Upload Medical Records[/fusion_button][/fusion_builder_column][fusion_builder_column type=”1_3″ layout=”1_3″ last=”false” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_color=”” border_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=”” min_height=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” first=”true” spacing_right=”2%”][fusion_title size=”3″ content_align=”left” style_type=”single solid” sep_color=”” margin_top=”5%” margin_bottom=”4%” class=”” id=””]Surgery Request[/fusion_title][fusion_button link=”/ci-surgery-request” color=”custom” size=”” stretch=”yes” type=”” target=”_self” title=”Commercial Insurance Request” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” bevel_color=”” icon=”” icon_position=”left” icon_divider=”no” modal=”” animation_type=”0″ animation_direction=”left” animation_speed=”1″ animation_offset=”” alignment=”” class=”” id=””]Commercial Insurance Request[/fusion_button][fusion_separator style_type=”none” top_margin=”” bottom_margin=”2%” sep_color=”” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” class=”” id=”” /][fusion_button link=”/pm-surgery-request” color=”custom” size=”” stretch=”yes” type=”” target=”_self” title=”Pain Management Request” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” bevel_color=”” icon=”” icon_position=”left” icon_divider=”no” modal=”” animation_type=”0″ animation_direction=”left” animation_speed=”1″ animation_offset=”” alignment=”” class=”” id=””]Pain Management Request[/fusion_button][fusion_separator style_type=”none” top_margin=”” bottom_margin=”2%” sep_color=”” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” class=”” id=”” /][fusion_button link=”/wc-surgery-request” color=”custom” size=”” stretch=”yes” type=”” target=”_self” title=”Workers’ Compensation Request” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” bevel_color=”” icon=”” icon_position=”left” icon_divider=”no” modal=”” animation_type=”0″ animation_direction=”left” animation_speed=”1″ animation_offset=”” alignment=”” class=”” id=””]Workers’ Compensation Request[/fusion_button][fusion_separator style_type=”none” top_margin=”” bottom_margin=”2%” sep_color=”” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” class=”” id=”” /][fusion_button link=”https://sn.ismosc.com/medical-clearance-form/” text_transform=”” title=”Medical Clearance Form” target=”_self” link_attributes=”” alignment=”” modal=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” color=”custom” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” type=”” bevel_color=”” size=”” stretch=”yes” icon=”” icon_position=”left” icon_divider=”no” animation_type=”” animation_direction=”left” animation_speed=”1.0″ animation_offset=””]Medical Clearance Form[/fusion_button][/fusion_builder_column][fusion_builder_column type=”1_3″ layout=”1_3″ last=”false” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_color=”” border_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=”” min_height=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” first=”false” spacing_right=”2%” spacing_left=”2%”][fusion_title size=”3″ content_align=”left” style_type=”single solid” sep_color=”” margin_top=”5%” margin_bottom=”4%” class=”” id=””]Scheduling Change[/fusion_title][fusion_button link=”/rs-surgery-request” color=”custom” size=”” stretch=”yes” type=”” target=”_self” title=”Reschedule Surgery Request” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” bevel_color=”” icon=”” icon_position=”left” icon_divider=”no” modal=”” animation_type=”0″ animation_direction=”left” animation_speed=”1″ animation_offset=”” alignment=”” class=”” id=””]Reschedule Surgery Request[/fusion_button][fusion_separator style_type=”none” top_margin=”” bottom_margin=”2%” sep_color=”” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” class=”” id=”” /][fusion_button link=”/cxl-surgery-request” color=”custom” size=”” stretch=”yes” type=”” target=”_self” title=”Cancel Surgery Request” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” bevel_color=”” icon=”” icon_position=”left” icon_divider=”no” modal=”” animation_type=”0″ animation_direction=”left” animation_speed=”1″ animation_offset=”” alignment=”” class=”” id=””]Cancel Surgery Request[/fusion_button][/fusion_builder_column][fusion_builder_column type=”1_3″ layout=”1_3″ last=”true” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_color=”” border_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=”” min_height=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” first=”false” spacing_left=”2%”][fusion_title size=”3″ content_align=”left” style_type=”single solid” sep_color=”” margin_top=”5%” margin_bottom=”4%” class=”” id=””]Account Information[/fusion_title][fusion_button link=”/account/” color=”custom” size=”” stretch=”yes” type=”” target=”_self” title=”View/Edit My Account” button_gradient_top_color=”#93c1ea” button_gradient_bottom_color=”#93c1ea” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”#1e73be” accent_hover_color=”#ffffff” bevel_color=”” icon=”” icon_position=”left” icon_divider=”no” modal=”” animation_type=”0″ animation_direction=”left” animation_speed=”1″ animation_offset=”” alignment=”” class=”” id=”” border_color=”#1e73be” border_hover_color=”#ffffff”]View/Edit My Account[/fusion_button][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]