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

Prior to your appointment print and complete:

 a) Patient Facesheet

b) HIPAA Privacy Receipt Acknowledgement

To Verify coverage of custom orthotics 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) Foot Exam Form

b) Medicare Therapeutic Shoe Bill

c) Therapeutic Shoe Bill Instructions for Physicians

d) Medicare Letter to Doctor's Explaining Requirements