New Patient Information Forms:

Thank you for choosing the Family Foot & Leg Center, P.A. We know that going to the doctor can be an inconvenient and stressful experience. In order to expedite your check in process at our office, please click on the links below to access the New Patient Forms. After you click the link, a browser window will open. After it opens, click on the 'PRINT' icon on your Browser. After the form prints, fill it out and bring them into our office. Completing the New Patient Information Form ahead of time will save you time.

Please contact our office at: (239) 417-2256 to schedule an appointment.

Please bring with you:

1. your insurance card
2. a form of government issued Identification.
3. medication list

The longest part of the check in process is the insurance verification process. If we have your registration form filled and insurance information in our system prior to your arrival our staff can get all that work done prior to your arrival.

Please fax or email the completed registration form as well as the financial responsibility form to: (866) 650-3324 or email them to: reception@familyfootandlegcenter.com.

Key Forms

Download
Interactive New Patient Registration Form* (Preferred Method)
New Patient Registration Form*
Notice of Privacy Practices

*You must have an Acrobat Reader to view the Acrobat files. If you don't already have Adobe Acrobat, you can download the Acrobat Reader Free.