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New Patient Forms

During the first visit, Dr. Miles and her staff will need to obtain important background information including your medical history. You will have time and opportunity to ask questions related to your diagnosis and treatment plan and to get to know your doctor.

Patient Forms
Please print and fill out the New Patient forms so we can expedite your first visit.

pdf podiatry patient form downloadNew Patients

Plan to arrive early so that we can complete your initial paperwork and process you in to our electronic medical record. Please help us by bringing the following:

  • Insurance card
  • Photo ID
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about your medical and surgical history, a typed list is very helpful
  • Recent test results, x-rays, or relevant records

Insurance and Payment Information

You are responsible for all co-payments, deductibles, or charges that are not covered by your insurance. Payment is due at the time of visit. We will make every effort at determining your financial responsibility in advance of your appointment. We accept cash, check, credit card with a convenience fee. We do not accept HSA cards. If you have questions regarding billing or which insurance plans we accept, please call one of our offices (386) 328-7228 or (904) 808-9950. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

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