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Family Footcare

Family Footcare

  • About
    • About Family Footcare
    • Meet the Doctors
    • Meet the Staff
    • Accepted Insurance
    • New Patient Forms
    • Office Locations
    • Newsletter
  • Services
    • Nail & Skin Conditions
    • Diabetic Foot Care
    • Sports Injuries
    • Foot & Ankle Trauma
    • Foot Pain
    • Stem Cell Therapy
  • Surgery
    • Surgical Facilities
    • Bunion & Hammertoe Correction
    • Nerve Surgery
    • Tendon & Fracture Repair
    • Reconstructive Surgery
    • Post Operative Care
  • Diagnostics
    • Ultrasound
    • Digital X-Ray
    • Biopsy
  • Products
    • Topical Skin & Nail Treatment
    • Nerve Restoration
    • Nutraceuticals
    • Wound Care
    • Arch Support
    • Diabetic Shoes
  • Contact

New Patient Forms

Your first visit to Family Footcare establishes a vital foundation for our relationship with you. 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. To understand what to expect for your first visit to our practice, please read through this page. You’ll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. You can even save some time at your first visit by printing out and completing the patient forms in advance of your appointment. Please remember to arrive 15 minutes early with your insurance card and photo ID as well.

We look forward to seeing you!
Family Footcare staff


Authorization Request Form

For use and disclosure of patient health information.
Download Form


Notice of Privacy Practices Form

This notice describes how health information is used.
Download Form


General Patient Information Form

General information form for first visit patients.
Download Form


History and Medical Information Form

History and medical information form for first visit patients.
Download Form


Patient Financial Policy Form

This financial policy form helps the practice provide quality care to our valued patients.
Download Forms


Late Cancellation and No-Show Policy

Important information regarding late cancellation and no-show.
Download Forms


Receipt of Privacy Policy

Written acknowledgment of receipt of notice of privacy practices.
Download Form

Primary Sidebar

About

  • About Family Footcare
  • Meet the Doctors
  • Meet the Staff
  • Accepted Insurance
  • New Patient Forms
  • Office Locations
Family Footcare logo
  • (203) 723-7884  • 1183 New Haven Road Naugatuck, CT 06770
  • (203) 792-3668 • 52 Federal Road Danbury, CT 06810
  • (203) 405-6501 • 77 Main Street North St. 104 Southbury, CT 06488
Family Footcare logo
  • (203) 723-7884 
  • 1183 New Haven Road,
    Naugatuck, CT 06770
  • (203) 729-3668 
  • 52 Federal Road,
    Danbury, CT 06810
  • (203) 405-6501 
  • 77 Main Street North St. 104
    Southbury, CT 06488

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