2701 NW Vaughn Street, Suite 424, Portland, OR 97210 (503) 243-2699

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.”

Medicare Agreement

This agreement is for all patients who are insured under Medicare. This form must be completed in order to provide treatment and states that the patient understands they will not be reimbursed by Medicare.

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.

Newsletter sign up

Stay up-to-date on clinic news, new products and community events

Something went wrong. Please check your entries and try again.