Patient Information

Medical Forms

Provided below are various forms that require completion prior to your visit and/or surgery. Please download the appropriate form as directed by your physician and/or staff by clicking on the name of the form.
Please bring the completed form/s with you to your scheduled visit. This will help expedite the registration process. Thank you.
(Forms require Adobe Reader)
Notice of Privacy Practices
Patient Registration Form
Patient History Form
Prior Surgeries Form
Release of Information Form
Request to Restrict Communication Form

About Your Visit

Insurance Information
Along with most major insurance plans, we accept Medicare, DOL (Dept. of Labor) and WC (Workers' Compensation).
Please call the office to make an appointment in advance. If you are unable to keep your appointment, please call us as far in advance as possible so we may use that time to see another patient in need of care. We make a sincere effort to adhere to our appointment schedule and appreciate your patience if we are late due to emergencies or hospital surgery.
Fees & Payments
We make every effort to decrease the cost of your medical care. Therefore, we request payment arrangements for all office services at the time they are rendered unless prior arrangements have been made. We accept cash, checks, Visa, MasterCard, American Express and Discover for your convenience. If we are a participating provider of your insurance company, we will bill them. However, payment is the patient's responsibility. We will help in any way we can to assist you in handling claims.
Prescriptions & Renewals
Please request all prescriptions and authorizations for renewals during our normal office hours, when our full records are available. Renewals requested at other times will be filled only for extreme or emergent circumstances.

Patient Testimonials

Mr. Curtis McCandles
Age 49, Measurement Technician for an oil and gas company, 3 children.
Procedure: Total Knee Replacement
Activities: Softball, Competitive Basketball, Golf, Score Keeper
“I could no longer play competitive basketball, run, or play softball anymore. I knew my knee was completely gone and my knee joint was coming apart. At this point I decided to do research about knee replacements on the web. I decided through research I wanted to have the Stryker Triathlon Knee put in. I then logged on to WebMD and found a Stryker friendly surgeon in my location, Dr. James A. Rosacker. After 6 weeks post op, my walk is almost completely normal, I can play golf, and follow my 12 year old son around. I am glad I made the decision to have my knee replaced.”
Mr. Jimmy Dyer
Age: 67
Procedure: Hip Replacement
Activities: Plans to take up Fishing
“I found myself dragging my leg which caused pain to my back. I could not sleep or climb into my pickup truck without severe pain. After putting up with overwhelming pain for 4 years I decided to see an orthopedic surgeon. After my visit with Dr. Rosacker I decided to have my hip replaced. I feel so much better now. I can sleep and climb into my truck without severe pain. If I would have known this before, I would have had my hip replaced 2 years ago. I was back to work on light duty 3 weeks after surgery. I had my surgery on Oct 24th, 2006 and I am now working full time. Dr Rosacker did a great job.”
Mr. William Painter
Age: 65, Retired Sheet Metal Worker
Procedure: Total Knee Replacement
“I could not walk far or use any type of stairs. I had put up with knee problems for 5 years and the pain just seemed to get worse. I finally made the decision to have my knee replaced. After one month of having knee surgery, I was out driving around and could walk better. My knee feels good and if I knew what I knew now, I would have had my knee replacement sooner.”
Quick Links:
Contact Details:
Fountain Park Orthopedics
3110 SW 89th Street
Oklahoma City, OK 73159
Phone:  (405) 378-8141
Fax:  (405) 703-7336