(239) 445-2112  -  

3530 Kraft Rd., Suite 201, Naples, FL 34105

Mark A. Klaassen, M.D.

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Patient Forms

Advance Directives

  • Notice of Privacy Practice
  • Patient Non-Discrimination Notice

New Patient Forms

Please print off and fill out these forms and bring them with you on your first visit.

  • Patient Information Form
  • Medical History and Orthopedic Screening
  • Authorization and Informed Consent for Treatment of a Minor
  • Consent to Access External Medication History
  • Physician Financial Disclosure
  • Acknowledgement of Receipt of OSMC Privacy Notice

Spanish Forms

Favor de imprima estas formas y traerlas con usted a su primera cita.

  • Forma De Informacion Paciente
  • Historia Medica Y Exploracion Ortopedica
  • Poliza Financiera
  • Directivas Avanzadas
  • Consentimiento Para Obtener Acceso Al Historial Externo De Medicamento
  • Reconocimiento Del Recibir La Notificación De Privacidad De OSMC
  • Delegación de Autorización

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Mark A. Klaassen, M.D.

3530 Kraft Rd., Suite 201
Naples, FL 34105

(239) 445-2112

©Mark A. Klaassen, M.D., 2025
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