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CHICAGO PEDIATRIC ORTHOTICS Bring to your first appointment:

  • Signed physician's prescription
  • Insurance card
  • Intake forms from bottom of this page.  
  • Identification 
  • Bring shorts if you or your child are being evaluated for lower limb braces or inserts for ambulation.
  • For spinal evaluation, we need to be able to see as much of the spine as possible.  For girls snug shorts and a bra or bathing suit top.  For boys, bike shorts, or boxer briefs.
  • Bring most recently worn brace or insole so we can discuss your preferences and improvements we can make.


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INSURANCE


We are currently contracted with the following insurance providers:    

  

Aetna - all policies


BCBS PPO


Blue Choice 


County Care


Illinois Medicaid


MedRisk


Medicare


Meridian


Multiplan


United Health Care 


and others please call to confirm


Forms to Fill and Bring to First Appointment

Please choose ONE and fill out the intake forms and bring them to your first visit.   Thank you!

Child Teen (Age 3 to 19) intake forms (pdf)

Download

Infant head shape evaluation intake forms (pdf)

Download

Infant-toddler (birth to 3 years) intake forms (pdf)

Download

Scoliosis intake forms (pdf)

Download

Late Policy-READ ONLY (docx)

Download

READ AND SIGN Rights & Responsibilities (docx)

Download