The following forms may be printed, reviewed, and completed prior to your visit to University Foot & Ankle Center. Please complete to the best of your ability. If you have any questions about the forms, or are unable to print a copy, please call (401) 861-8830 and ask to speak to an Appointment Scheduler.
All new patients must complete a Patient History or update an existing record if you are a returning patient. Please consider using our convenient Secure Online Patient Intake Form. Obtain your Authorization Code when scheduling your appointment - or download and print the Patient History and Patient Agreement forms listed below:
New Patient Consent for The Use and Disclosure of Health Information for Treatment & payment & Healthcare Operations
Patient Request for Confidential Disclosure of Protected Healthcare Information
NOTE: Please do not FAX these forms to the office. Bring them with you at the time of your visit unless you have been instructed otherwise by a University Foot & Ankle Center representative.
At the time of the initial office visit, we will need a little extra time to become familiar with your medical status. Even if you have a minor problem, this can be important, so we schedule extra time for this interview. It is helpful if you come in at least 10 minutes prior to your scheduled appointment time to take care of paperwork.
The doctor will perform a thorough exam, x-rays will be taken if necessary and a treatment course will be discussed. Usually steps can be taken to relieve painful symptoms at the initial visit.
The Physicians' Choice
We are proud of the fact that the majority of our new patients come from physician referrals and existing patient referrals.
Click here for a full list of our services.
Specialized Treatment and Surgery - click here
Medicare Diabetic Shoe Program
Diabetes is reaching epidemic proportions in the United States. During the past decade, there has been an increase of 33% with the diabetic population currently topping 16 million people. There are many complications associated with diabetes including kidney, heart, vision, circulatory and foot problems. The good news is that many of these potential problems can be minimized as a result of life style changes, medications and other preventive care.
Amputations, or partial amputations, of the feet and legs are also growing at an alarming rate. In fact, it is the leading cause of non-traumatic amputation in the United States. Recently a task force was created by officials from Medicare, the American Podiatric Medical Association and the American Diabetes Association in order to explore ways to reduce the number of amputations in the diabetic populations. The number of these lower extremity amputations grew by 28% in just the past several years. However, it has been determined that over half of these amputations could have been prevented by timely conservative foot care.
We at University Foot & Ankle Center are authorized Medicare Suppliers to evaluate, prescribe and dispense high quality diabetic shoes and 3 pairs of removable protective shoe inserts per calendar year. Many diabetic patients qualify for this benefit and Medicare will pay 80% of the cost for the shoes and insoles and your supplemental insurance should pay the other 20%.
[ Return to top ]