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F W Toenges & Sons, Inc, Shoes - Retail, Fort Wayne, IN

These forms are required if you plan on going through insurance on our Pedorthic side:

Prior to your appointment print and complete:

 a) Patient Facesheet

 b) HIPAA Privacy Receipt Acknowledgement

To verify coverage of custom orthotics please print, complete and bring to the store:

 Insurance Verification Form for Patients

Medicare Diabetic Shoe/Insert Coverage (print and take to M.D. or D.O. treating Diabetes)

a) Annual Comprehensive Diabetes Foot Exam Form

b) Fred Toenges Therapeutic Shoe Bill

c) Medicare Therapeutic Shoe Bill Instructions for Physicians

d) Medicare Letter to Doctor's Explaining Requirements

e) Certifying Physician Requirements Criteria