Forms and Policies

Thank you for allowing us the opportunity to serve you!

On your first visit, please arrive 15 minutes earlier for the registration process or you may choose to pre-register by downloading, printing, completing, and signing the forms below. Please be sure to bring them with you on your first visit. Completing the forms prior to your visit will help speed up the new patient registration process.

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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

Please click to access the following forms/policies:

pdf podiatry patient form downloadNew Patient Registration

pdf podiatry patient form downloadFinancial Policy and Office Procedures

pdf podiatry patient form downloadInsurance Benefits/Payment Policy

pdf podiatry patient form downloadAcknowledgment of Access to Notice of Privacy Practices

pdf podiatry patient form downloadRegistro de paciente nuevo

pdf podiatry patient form downloadPolitica Financiera y procedimientos de la oficina

pdf podiatry patient form downloadPolitica de beneficios de seguros y pagos

pdf podiatry patient form downloadReconocimiento de haber revisado el aviso de practicas de privacidad

HIPAA

Our patients have the right to receive a notice of this practice’s privacy notice; thus, we have prepared a notice of privacy practices. This notice is provided to all our patients on their first visit and can also be accessed here:

pdf podiatry patient form downloadNotice of Privacy Practices

pdf podiatry patient form downloadAviso de practicas de privacidad

Financial

Foot Center McAllen Weslaco will make every effort to collect payment from your insurance company. If your insurance company fails to pay within a reasonable time or pays only a portion of the bill, you are responsible for payment of the remaining balance. Please access the practice’s financial policies here:

pdf podiatry patient form downloadFinancial Policy and Office Procedures

pdf podiatry patient form downloadInsurance Benefits/Payment Policy