Welcome to our Practice!
We thank you for giving us the opportunity to participate in your health care. Our mission here at Complete Foot and Ankle Specialists, LLC is to keep you happy, healthy, and active. We do this by learning about your personal situation and providing a comprehensive foot care plan that is tailored to your needs.
To help make your first visit a convenient and a pleasant experience, we ask that you complete the following patient forms prior to your arrival. For your convenience, forms may be completed electronically through our secure website.
- Patient Registration and Insurance Form
- Patient Registration and Insurance Form (Online)
- Signed Financial Policy
- Signed Financial Policy (Online)
- Patient Medical Information Form
- Please be sure to list of all your medications, vitamins, and supplements, including strength and dosages.
- Patient Medical Information Form (Online)
- Patient Privacy Form
On the day of your appointment, please bring the following with you:
- Medical Insurance Cards
- If no insurance card is presented at the time of your appointment you may be asked to reschedule your appointment or payment is due in full. We cannot bill your insurance unless we have a copy of the card on file.
- Photo ID
- Your photo ID is required at the time of check-in to protect you from identity theft.
- Referral authorization from your primary care physician, if required by your insurance.
- Please note, you cannot assume your referral was approved unless you have received confirmation from your insurance company. Please call your primary care physician to make sure your referral was completed prior to your appointment. If you have any questions, please feel free to call our billing department prior to your appointment at 937. 404. 2455.
Please be prepared to pay for the following at the time of your visit:
- Co-payment and /or Co-Insurance
- Our office accepts cash, check, Visa, Master Card, Discover and Care Credit
- If you do not have insurance, payment is due in full at the time of service.
We ask that you arrive 15 minutes early to give our staff adequate time to finish your registration. If you are unable to complete your paperwork online prior to your appointment, we ask that you arrive 30 mins prior to your appointment.
If you have any questions prior to your appointment, please let us know. We look forward to meeting you.
Our practice is working together to realize a shared vision of uncompromising excellence in podiatric care.
To fulfill this mission, we are committed to:
- Listening to those we are privileged to serve.
- Earn the trust and respect of patients, profession and community.
- Exceed your expectations.
- Ensure a creative, challenging and compassionate professional environment.
- Strive for continuous improvement at all levels.
Please print, fill in and sign the applicable forms below:
- New Patient Paperwork
- New Patient Paperwork (Online)
- Financial Agreement Form
- Financial Agreement Form (Online)
- Privacy Notice
- Designation For Release of Medical Information
- Designation For Release of Medical Information (Online)
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
What to expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familarize yourself with the doctors. We look forward to your first visit.