FAMILY FOOT CARE
If you would like to make an appointment, please call our office today.
If you are a first-time patient, complete a copy of the new patient form you will find below or in PATIENT FORMS . Please complete all 4 pages of the New Patient Form and mail or fax to the appropriate office BEFORE your scheduled visit. To help you get the most benefit from your insurance coverage we must have your information prior to your scheduled visit.
What to Bring to Your Appointment
* Photo Identification
* Insurance Cards
* Any required co-payment
* List of all medications that you take on a routine basis, including vitamins and supplements.
* Minors must have parent or legal guardian present at time of visit. Guardians must present notarized documentation to authenticate custody.
Patient Policy Agreement
In Consideration of receiving services from Family Foot Care, you agree:
1. All services are provided to you with the understanding that you are responsible for the cost regardless of your insurance coverage. Please be aware that not all services are a covered benefit with different insurance companies. You are responsible for knowing what services are and are not covered. KNOW YOUR BENEFITS.
2. Prior to time of service, we will collect your deductible, co-pay and payment for any uncovered services as well as the patient’s portion as determined by insurance for any in/outpatient surgery or in office procedure(s). We accept cash, check, debit card and credit cards (MasterCard, Visa and Discover). Returned checks for insufficient funds will be subject to a $30.00 return check fee.
3. Your insurance policy is a contract between you, your employer and the insurance company. We are NOT a party to that contract. It is your responsibility to notify this office immediately if your insurance coverage or company changes. It is your responsibility to understand your coverage and benefits, including pre-certifications, referral and authorization requirements and to be sure all insurance information that we have is current. It is your responsibility to determine whether Family Foot Care is “In Network” with your insurance company.
4. We will bill your insurance company as a courtesy but you are still ultimately responsible for payment of all services rendered. If your insurance company has not responded within 60 days of claim submission, a statement will be sent to you. You should call your insurance company to question why the claim has not been paid. Our office will assist you only after you have contacted your insurance company.
5. ANY unpaid charges over 90 days old will be considered for an outside collection agency.
6. Release of Information: I assign benefits of my medical insurance contract to Family Foot Care and authorize payment directly to Family Foot Care. I authorize Family Foot Care to release medical information to payers as required for payment of claims for medical services.
7. Missed appointment policy: A missed appointment is an appointment where the patient does not call to cancel and then fails to appear. This time is reserved for and set aside for you. Failure to cancel an appointment within 24 hours of appointment time will result in a $25.00 cancellation fee. This is not covered by insurance and will be billed directly to the responsible party.
8. Bad Weather Day Policy: In the event of inclement weather the office may be closed. If school is closed for the safety of the students, we will close for the safety of our patient’s as well as our staff.
9. Cell Phone and Camera Use: Cell phones/electronic devices should be turned off in the treatment areas unless instructed otherwise by the physician/staff. Device use in the treatment areas is disruptive to patient care and interferes with the doctor/staff and patient interaction. Photography/video recording is not allowed at any time in the treatment areas with the exception of the medical staff taking photographs for documentation purposes for the patients’ chart.
10. Surgery Cancellation Policy: When scheduling surgery please be advised that this is quite time consuming. Therefore; cancelling surgery for any reason other than pre-screening recommendations will result in a $75.00 cancellation fee for the Hospital/Surgery Center procedures and $50.00 for office procedures.
We would like to take this opportunity to thank you for choosing our practice for your foot care.
We diagnose and treat a variety of podiatric conditions, including the following:
Allergic contact dermatitis
Diabetic foot care
Flatfoot (fallen arches)
Onychomycosis (nail fungus)
Pediatric foot care
Posterior tibial dysfunction
Tarsal tunnel syndrome