Orthopedics & Sports Medicine
Please provide your information so we know who is sending us the referral
Referred by
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Referring clinic
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Referring clinic phone number
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Email address
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example@example.com
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Orthopedics & Sports Medicine BayCare Clinic information
Preferred place of service
*
Please Select
Green Bay
Kaukauna
Marinette
Manitowoc
Shawano
Sturgeon Bay
Green Bay providers
Please Select
No Preference
John Awowale, MD
Jason George DeVries, DPM
Kirk Dimitris, MD
Jon Henry, MD
Andrew Kirkpatrick, MD
Brian J. Klika, MD
Jeremy M. Saller, MD
Brandon M. Scharer, DPM
Harold J. Schock, MD
Michael Schnaubelt, MD
Ryan Woods, MD, RMSK
Chad Zehms, MD
Kaukauna providers
Please Select
No Preference
Kirk Dimitris, MD
Brian J. Klika, MD
Brandon M. Scharer, DPM
Harold J. Schock, MD
Ryan Woods, MD, RMSK
Marinette providers
Please Select
No Preference
John Awowale, MD
Kirk Dimitris, MD
Andrew Kirkpatrick, MD
Brandon M. Scharer, DPM
Ryan Woods, MD, RMSK
Manitowoc providers
Please Select
No Preference
Jason George DeVries, DPM
Carl A. DiRaimondo, MD
Jon Henry, MD
Craig L. Olson, MD
Brian J. Klika, MD
Brian Kurcz, MD
Shawano providers
Please Select
No Preference
Jeremy M. Saller, MD
Michael Schnaubelt, MD
Sturgeon Bay providers
Please Select
No Preference
John Awowale, MD
Andrew Kirkpatrick, MD
Jeremy M. Saller, MD
Ryan Woods, MD, RMSK
Appointment scheduling
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Please call our patient
Our patient will contact your office
Appointment already scheduled
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Patient Information
Name
*
First Name
Last Name
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for consult
*
Clinical photos / X-rays
*
Being mailed
Hand carry
Need to be taken
Attached
Not needed
Cause of injury
Workers' compensation
Personal injury
Motor vehicle accident
Side of patient's body
Left
Right
Both
Reason for consultation
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