Patient Forms
Please print and fill out the New Patient forms so we can expedite your first visit.
New Patient Form Basin Podiatry
Basin Podiatry Privacy Annually
Basin Podiatry Consent/Annually Done
Diabetic Shoe Forms Available Here To Have Your Primary Care Physician Fill Out To Get Your Diabetic Shoes If You Qualify on Medicare!
Certificate of diabetic shoe evaluation
Statement of Medical Necessity prescriptions shoes
Please arrive early so that we can complete your initial paperwork. Also, please bring the following:
- Patient’s insurance card
- List of current prescriptions and/or over-the-counter medication, including dose and frequency
- Information about patient’s medical and surgical history
- Recent test results, x-rays, or relevant records
Insurance and Payment Information
You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please call (432) 550-3668. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.