New Patient Forms

Please Download and then Print the 3 forms listed below, and fill out prior to your appointment with us…any questions about these forms, feel free to give us a call (607) 217-5668 or email us at happyfeet@southerntierpodiatry.com

Remember to also bring your Insurance Card(s) with you, and be sure to obtain a referral (if needed) prior to your appointment.

If you are unsure if a referral is required, please call your insurance carrier to find out. The referral is then obtained from your Primary Care Physician.

1. Patient Information Form
2. Medical Information Form
3. Office Billing & Financial Policies Form

We have also made available our office’s Privacy Practices / HIPAA Form. Please review, and if any questions, please ask. This is available for your information. You do not have to print this form out prior to your 1st appointment with us.

Notice of Privacy Practices/HIPAA Form