Patient Information Form
To help you prepare for your first visit, please print and complete this form before you arrive.
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Preparing For Your First Visit
When you call to schedule your first appointment, our receptionist will ask you about your specific situation so we can properly prepare for your initial visit. We will ask who referred you to us, if your doctor has given you a prescription and what insurance coverage you have. We will try to schedule a time that is convenient for you.
What information should you bring?
You should bring your prescription from your Doctor, insurance information, X-rays (if available) and a family member or close friend. They will help you remember conversations, instructions and will most likely ask questions you may not have thought to ask.
If you already have prosthesis/orthosis be sure to bring it along even if it is broken or you have outgrown it.
Plan on arriving a few minutes early. You will be asked to fill out our medical information forms and we will make a copy of your insurance card.
When You Arrive
You will be shown to a patient room specific to your needs and one of our practitioners will begin their initial, comprehensive evaluation. You will be asked questions about the nature of your condition and probing questions about your lifestyle, interests and levels of activity. The more we know about you and how you live, work and play, the more effective we will be in successfully creating a device appropriate to your needs. We will discuss you options.
Measuring for the device. Depending on your situation the practitioner may measure or take a custom impression for your prosthetic or orthotic device.
Schedule your follow-up visit. As you leave you will be asked to make a return appointment for the actual fitting of your prosthetic or orthotic device.
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