New Patient Forms
Please bring those forms with you or fax to 312 944 0007

Patient Health History

Patient Registration

Patient Rights and Responsibilities 

Orthotic Information

We understand how important your time is, and do our best not to keep you waiting.  Unfortunately, we cannot predict emergencies or the seriousness of each appointment, our office staff will ask you what is the nature of your appointment, please understand that this is in effort to provide the appropriate time for your appointment.  At times, emergencies can cause us to run late.  We appreciate your patience and strive to make your appointment as pleasant as possible.

 
Billing
We encourage all patients to read their insurance policy handbook and to become familiar with their coverage, deductibles and co-pay amounts, policy limitations, exclusions and pre-certification requirements. As insurance plans and coverage benefits change on an ongoing basis, it is the responsibility of the patient to check with their insurance company and plan to ensure that we are a participating provider in their particular plan and that they have benefits for podiatric services. We participate with many medical insurance plans, including Medicare. We do NOT participate in IDPA. The ONLY HMO that we accept is United Healthcare HMO and you must have a referral from your primary care physician with you at your office visit. We DO NOT participate in any other HMO plan. If we are a participating provider on your plan, we will accept your valid insurance card for the services we provide you. Your co-payment will be required at the time of service. Any deductible applied to our fee or non-covered charges will be your responsibility. We will file a claim on your behalf to your insurance company. We do require a current copy of your insurance card and should your insurance change or be canceled please make us aware when scheduling your next appointment.  If we render services and your insurance information in invalid, you will be responsible for the expenses incurred at the visit. 

We do require credit card information (V, MC, AMEX, HSA, or FlexSpend card) to be kept on file with our office. We respect and understanding privacy concerns. This information is stored securely in your electronic record.