Forms To Prepare For A Visit

• Patient Privacy Statement
• Patient Information Sheet
• Patient Rights Statement
• Diabetic Shoe Statement
• Supplier Standards
• Warranty Policy

Patient Information Forms

• Patient Information Form – English Version
• Patient Information Form – Spanish Version (Informacion del Paciente)
• Medicare Supplier Standards
• Patient Satisfaction Survey

HIPAA Release Forms

• Acknowledgement of Receipt of Notice of Privacy Practices
• Patient Consent for Purposes of Treatment, Payment and Healthcare Operations
• Notice of Privacy Practices