Patient Information

When coming to Foot and Ankle Specialty Clinic, new patients should bring:

• Picture Identification (Driver’s License, Passport, etc.)
• Health Insurance Card(s)
• List of Medications
• Payment for all services rendered at time of visit. 

Please make note of the following:

• If you are a new patient and have not completed your new patient paperwork, please arrive 15-20 minutes prior to your appointment time. This will allow time for completion and processing of your new patient paperwork.
• Payments for services rendered are due at time of service. (This includes any Copayments, Deductibles, Coinsurances, and Account Balances)
• If you are unable to pay for services, we will not be able to schedule or keep your appointment.
• Insurance Verifications will be done for every appointment.
• Medicaid patients are required to have a Primary Care Physician Referral every 6 months to maintain appointments.
• All VA patients are required to have a Referral and Authorization for each visit.
• All Medicare and Medicare Advantage plan patients who are being seen for routine care visits, are required to be seen by their Primary Care Physician every 6 months to be able to be seen in our clinic.
• We do not see patients for visits pertaining to an ATV or Motor Vehicle Accident. We do not accept Vehicle Insurance.

Our office has a pre-payment policy for all X-ray and Medical Records requests.

A fee of $15.00 is due for any and all Medical Record/Chart documentation (price for 1 page or more)  

A fee of $10.00 is due for any X-ray disc only requests.

A fee of $25.00 is due if both X-ray and Medical Records are requested.

Payment is due before documentation can be picked up.

There is a 14-business day wait for documentation pick up. All documentation must be picked up in the clinic by the patient or guarantor listed on the patient’s account. There will have to be an Authorization for Release of Medical Records on file before any party other than the patient or responsible guarantor can pick up documentation.

* NEW PATIENT PAPERWORK - CLICK HERE FOR PDF. Please PRINT and FILL OUT this form prior to your visit. Bring with you to your first appointment. 

* PRIVACY PRACTICE NOTICE - CLICK HERE FOR PDF.