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Authorization for Payment
| Mandatory form. It allows us to submit claims to your insurance on your behalf. |
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Confidential Patient Information
| Mandatory form. Every new patient needs to fill out this form. |
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Waiver of Liability
| Mandatory form. Not all services are covered by your insurance. This form must be signed in order for such services to be rendered. |
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Notice of Privacy Practices
| This form describes how we safeguard your personal information. |
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Record Release
| Fill out this form only if you want to have us release your records to another physician or obtain your own copy. There is a small charge for this service. |
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Pre-Operative PCP Clearance
| If you require surgery and must have clearance from your primary care physician, print this form and have your doctor fill it out and send it to us. |
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Routine Footcare Form
| This form must be printed and filled out by your primary care physician in order for routine footcare services to be covered by Medicare. |