New Patients
Please print and bring these completed forms to your appointment or arrive 15 minutes early to fill them out in the office.
*Return patients who have not been seen in 3+ years are required by Oregon law to be re-admitted as a “New Patient.”
Medical Release Form
Please print and complete this form and submit it to us within 48 hours of scheduling an appointment.
*Return patients who have not been seen in 3+ years are required by Oregon law to be re-admitted as a “New Patient.”
Insurance Acknowledgement Form
This agreement is for all patients. This form must be completed in order to receive treatment and states that the patient understands we will not bill insurance and our visit may not be covered by their insurance.
Remote Consultation
The following information is required and must be submitted before scheduling a consultation.
- All remote consult forms
- At least one top-view picture of your feet while standing on insoles or liners pulled out of your most-used footwear.
- Optional: If you own Correct Toes, please include a picture of them on your feet.
- Optional: If you have recent (past 3 years) X-Rays or MRIs of your feet or ankles, please send the images on a disc and the report via postal mail.