Patient Forms


 

Thank you for choosing Foot & Ankle Premier Specialists. During your first visit, please arrive early to complete initial paperwork or print and fill out the forms below so that we can expedite your first visit.

 

NEW PATIENT FORMS

MEDICAL RELEASE FORM

HIPAA RIGHT OF ACCESS FORM FOR FAMILY MEMBER

HIPAA

 

 

To help us enhance your quality of care, please bring important medical information to help us optimize your visit:

  • Patient’s insurance card
  • Medical and surgical history
  • Prescription medication list and/or over-the-counter list
  • Previous doctor(s) notes
  • Blood work
  • Biopsy reports
  • Recent Xray, MRI, Ultrasound report

 

Insurance and Payment Information

You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please call our Hoboken office. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

 
 

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