© 2019 A New Step Foot & Ankle Clinic, PLLC

PATIENT FORMS

 

We have important documents that we ask you to review, fill out, and/or sign prior to your first office visit, and bring them with you to your appointment. Please fill out and sign the forms where requested, prior to coming to your first visit with us. Your check-in time will be reduced if you can spend some time on these forms at home.

Patient Information

The patient information and history form (.pdf) provides us with your basic demographic and insurance information so that we can contact you as needed and bill your insurance appropriately. Please sign the bottom of the form and make sure to include proper subscriber information.

 

Your answers on this patient history form will help your health care provider get an accurate history of your medical concerns and conditions. If you are a new patient please complete all pages. If you cannot remember specific details, please provide your best guess. If you are uncomfortable with any question, do not answer it.

HIPPA

HIPPA is a Notice of Privacy Practices. The U.S. Department of Health and Human Services (“HHS”) issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  You will be provided with the most current version of this form upon your arrival for signature.