Albemarle Family Foot & Ankle, P.L.L.C.

Please print and bring these completed forms - along with your insurance card(s) and photo ID - with you to your first scheduled appointment.

Please print, review, and sign these consent forms to bring with you on your first visit.

Thank you!!

Please print and complete these forms - if applicable.

Tips for your first visit:

• Be sure to bring your insurance card(s) and a photo ID with you.  We CAN NOT bill your insurance if you do not bring these items with you to your appointment.

• It is helpful to have a printed list of all medications - including the dosage -(prescription and over-the-counter) that you may be taking.

• If you wear orthotics or inserts in your shoes, be sure to wear or bring them with you.