Westmoreland Foot and Ankle Care Patient Forms

 
 

Below you will find our Westmoreland Foot and Ankle Care patient forms. Please click the appropriate form and fill out here online. Once you have completed the form, print it out and bring in with you on the day of your first appointment. This will help us expedite your check in process when you come in. If you have any questions, please feel free to give us a call!

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

Please remember to bring the following items to your appointment:

  • Health insurance cards

  • Photo ID

  • Your primary care doctor’s contact information and date last seen

  • A list of any medications you are taking (prescription and over-the counter)

  • A referral from your primary care doctor (if required by your insurance carrier)

  • Any previous x-rays, MRI’s other test results relating to any past foot health conditions

  • If you are a diabetic – It would be helpful to either bring or have your primary care physician fax me a copy of your most recent blood work.

Other Office Recommendation & Policies:

  • Remove all nail polish prior to your visit

  • Do not put any cream or ointments on your feet the day of your visit.

  • All minors (under 18) must be accompanied by an adult with authority to consent to the minor’s treatment.