New Patients

On-line New Patient Forms

To expedite your appointment we recommend all new patients to complete our on-line patient forms.  This will help our staff and doctor review your medical history before your appointment and in-put all necessary information into our electronic health records. Make sure that you list all medications with correct spellings and dosages.  Previous surgeries should have at least a year when performed.

Completing these forms on-line will require you to arrive ½ hour prior to your appointment time as opposed to 1 hour.

Please be aware that this can take between 20 to 45 minutes to complete based on the complexity of your medical history. We encourage you to leave enough time to complete this process in it's entirety. If you are unable to complete all the forms in one sitting you can use the links below to start where you left off.

You will be completing 5-6 sections (based on your age) including:

1. Patient Information
2. Medical History
3. PAD Questionnaire (only necessary for patients 50 years old and over)
4. Office Policy Consent
5. HIPAA Consent *Please read our Notice Of Privacy Policy and Red Flag Rule Compliance Agreements Below
6. Easy Pay Policy Form

At the end of each form you will be directed to ‘Submit’ the form and a ‘Thank you’ page will appear if successful. This page will in turn direct you to the next section to complete. Once you have completed all sections, a final successful ‘Thank you’ page will appear and you will be given further directions on how to prepare for your appointment with the doctor.

• Click Here to Begin your New Patient Forms On-Line

Printable New Patient Forms

If you are unable to complete our on-line new patient forms above please print the link below and fill out all pages and bring with you to your appointment. Make sure that you list all medications with correct spellings and dosages. Previous surgeries should have at least a year when performed.

If using this method we require you to arrive 1 hour prior to your scheduled appointment time.

• Printable New Patient Forms

In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.

On-Line Existing Patient Update Questionnaire

Please take the time to complete our on-line update questionnaire if you are a returning patient that has not been seen in the past 6 months or more. This will help our staff and doctor review your medical history before your appointment and in-put all necessary information into our electronic health records.  This will also assure that your appointment stays on-time to afford you the most time with your doctor.

As always please arrive 15 minutes prior to your appointment time.

• Click Here for our on-line Update Questionnaire

Printable Existing Patient Update Questionnaire

If you are unable to complete the on-line form above, please take the time to complete our printable update questionnaire if you are a returning patient that has not been seen in the past 6 months or more.  Remember to bring the completed form with you to your appointment.

As always please arrive 15 minutes prior to your appointment time.

• Patient Update Questionnaire

*Please take the time to read our HIPAA and Red Flag Rules Compliance Agreements.  Click the links below:

• Notice Of Privacy Policy-HIPAA
• Red Flag Rules Compliance

What to expect at your new visit:
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctor. We look forward to your first visit.

Referrals

Patient Referral Bonus Rewards
Here at the Advanced Footcare Clinic new patients are always welcome! In recognition of your continued support and loyalty to our clinic we would like to extend our gift to you for recommending our practice to your family and friends.

With every successive referral the reward grows! Just a token of our appreciation that you have put your trust in us for providing all your foot care needs.

Doctor Referrals
To make it easier for our referring doctors we have established a tear-off pad to give to your patients who need podiatric services. It explains where to get our 'new patient forms' and a quick check off list on the back of their particular ailment.

Please click here for a printable version of our referral pads. You can also e-mail us at [email protected] for more booklets.

Thank you for all your continued support through the years.