New Patient Demographic Forms: Please print, fill out, and bring with you on your first visit. If you would prefer to fill one out at your first visit, we will have copies available to you, but we ask that you arrive at least 15 mintues prior to your appointment time.
Release of Medical Records: To provide the best care possible, we often request medical records from your physician, surgeon, or medical testing provider. Many medical practices have medical records requests handled by another company. This form will allow us to receive medical records from that company. Please print, fill out, and bring with you on your first visit. If you would prefer to fill one out at your first visit, we will have copies available to you, but we ask that you arrive at least 15 minutes prior to your appointment time.
For Orthotics Only:
Please review our Orthotics Policy for custom made orthotics. A deposit of $142.00 will be expected at the time of casting.
We also offer “Outgrow” insurance for the cost of $60.00. This gives your child a 2 year guarantee on orthotics should they outgrow their current set from the original purchase date.
For Self Pay Only:
Please review, sign and return our Self Pay Policy. Our good faith estimate of self pay services is $150 per evaluation (first visit) and $80 per treatment session (subsequent visits). Payment is expected at the time of service. Please download the following form for more information and to sign up for the self pay option.