New Patients
Key Forms
New Patient Information Forms:Thank you for choosing the Family Foot & Leg Center, P.A. We know that going to the doctor can be an inconvenient and stressful experience. In order to expedite your check in process at our office, please click on the links below to access the New Patient Forms. After you click the link, a browser window will open. After it opens, click on the ‘PRINT’ icon on your Browser. After the form prints, fill it out and bring them into our office. To further expedite your visit, we encourage you to use the HIPAA compliant forms submission portal for your documents so that we may prepare ahead of time for your visit. Completing the New Patient Information Form ahead of time will save you time. Please contact our office at: (239) 430-3668 option 2 to schedule an appointment, or use our Self Service Patient Portal. Please bring with you:
Completing and submitting the forms below ahead of your appointment will help to expedite the check-in process as insurances must be verified for the safety and financial security of both parties. Sometimes we have to be on the phone with insurance companies for 15-20 minutes to get the information required, please help us be prepared for your visit to make it go as smooth as possible. If you have trouble using the submission portal below, you may fax completed registration form. Please fax completed registration form, financial responsibility form, medication list if any to: 239 692 9436 though submission portal below is preferred method. Instead of faxing you may also use this form to securely send your SIGNED registration form, medication list, insurance card, clinical photos if you like for your files way prior to your arrival so that we may prepare for your arrival Or now you can submit your patient forms, medication list, even photos of your problem via our HIPPA secured registration portal to our patient service representative This will save you time at check in area.
| ||||||
