911 S. Washington Street, Ste. B
Kennewick, WA 99336-5604

Telephone: 509-586-2828
Facsimile: 509-586-2525

Welcome to Benton Franklin Orthopedic Associates
 

If this is an emergency or urgent problem go to the nearest emergency room.  It may take up to 24 to 48 business hours for us respond to this request.

Please fill out this form as completely as possible and we will call you to arrange an appointment.

  I am a new patient.      I am an existing patient.
Name:
Address:
City: State: Zip:
Health Insurance:
My Physician is:

My Availability is: 
Monday between the hours of      
Tuesday between the hours of     
Wednesday between the hours of
Thursday between the hours of    
Friday between the hours of        
I prefer the
Please Contact me at: (Telephone #)

To save you time please print out and complete our Patient History Form and Patient Information Form located to the right. 

 

Downloadable Forms

 
HIPPA Notice of Privacy Practices

Patient History Form

Patient Information Form

 

Copyright © Benton Franklin Orthopedic Associates 2006. The information contained herein may not be duplicated, copied or reproduced by any  means without the express written permission of Benton Franklin Orthopedic Associates.