Patient Information
Welcome to Fort Lee Podiatry Group, LLC
New Patient Form
TO SAVE TIME, YOU CAN FILL OUT YOUR FORM BEFORE YOUR SCHEDULED VISIT.
Click on the button below to download the convenient PDF fillable form to be completed for your visit. Fill out the form in its entirety. Please note: you will need Free Adobe Acrobat Reader or Preview on a Mac to view and type into this form,
What to Bring to Your Appointment
Patient's Health Insurance Card(s)
Photo ID
Primary Care Doctor's name and telephone number
Referral From Your Primary Care Doctor (If Required By Your Insurance Carrier)
List of current prescriptions and/or over-the-counter medication, including dose and frequency
Information about patient's medical and surgical history
Any Previous X-Rays, MRIs or Test Results Relating To Any Past Foot Health Conditions
Cancellations
If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours notice. We ask for this advance notice so that we can offer this appointment to another patient. A fee may be charged if a patient does not show up for an appointment without sufficient notice.
Educational Forms
If you don’t have Adobe Reader, please use the forms below:
