New Patient Forms

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New Patients

During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor. We accept most insurances.

Patient Forms

Please print and fill out the New Patient forms so we can expedite your first visit.

PDFNew Patient Form Basin Podiatry

PDFBasin Podiatry Privacy Annually

PDFBasin 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!

PDFCertificate of diabetic shoe evaluation

PDFStatement 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.

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