|
|
|
|
PATIENT FORMS
Certifying Physicians Statement
A Certifying Physicians Statement and a Rx (Prescription for Diabetic
Shoes and diabetic insoles) must be completed by your primary care
physician BEFORE shoes and/or orthotics can be dispensed. Click link to print form.
Patient Information Sheet. To expedite your appointment please fill this out prior your visit. Click link to print form.
Notice of Privacy Practices (HIPPA) For your information to read. Click link to print information.
Patient Consent Form Click link to print form.
|
|
|
|
|
|
Copyright 2007 © The Shoe Smith; All rights reserved.
|
Insoles and Orthotics