New Patient Forms

Welcome

Thank you for choosing Nigro Foot and Ankle Care for your foot and/or ankle care. Please know that our doctors, nurses and administrators value the trust you have placed in us and will do all they can to meet your expectations for quality medical care.

What to Bring to Your First Visit

We believe that the patient-doctor relationship is integral in keeping our patients healthy.

Our physicians want to make your first visit with us a success and are interested in learning as much as possible about your current health status. Please arrive 15-20 minutes early so you have time to fill out our health status forms, which help the physician learn about any areas requiring care. Filling out these forms will help your physician make the most of your time together.

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.

If you are insured, the office staff will ask to see your insurance card.

New Patient Intake Form

All new patients are asked to fill out a New Patient Intake Form, so our Doctors can better prepare for your specialized care.

My Medicine List Form (For All Patients)

My Medicine List – This form helps you and your family members remember all of the medicines you are taking. Take this form with you on all visits to your clinic, pharmacy, hospital, physician, or other providers. More detailed directions are included on the form.

Please print out the following forms at home prior to your appointment, fill them out, and bring them with you to your appointment. If you do not have these forms completed upon your first office visit you will be provided with a blank copy and asked to complete the forms in the waiting room prior to seeing the Doctor.


Document Name PDF Format Word Format
NIGRO – New Patient Intake Form
Updated May 2014
NIGRO – My Medicine List Form
Updated May 2013

If for some reason you are unable to open a PDF file a hard copy will be available in the office prior to your appointment.

• For our physicians to treat you most effectively, we will ask you to fill out a patient information questionnaire at your first visit. Please bring information about past and current medical treatments and illnesses you have had, including approximate dates. Please have your primary care doctors name and number.

• Know if you have met your insurance company’s deductible. If you are not sure, call your insurance company. A toll-free number will be on your insurance card.

• If you are a Medicare patient, remember there is an annual deductible that must be met.

• You will be responsible for the amount of co-payment at the time of treatment. We accept cash, checks, debit/credit cards (MasterCard/Visa).

• If you are insured with a HMC (Heath Management Corporation) you will need a referral from your primary care physician before we can treat you. Please contact your insurance company to see if a referral is required before scheduling and have your PCP fax the referral to our office.

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