EN

Translate:

image4

Bring to your first appointment:

  • Signed physician's prescription
  • Insurance card
  • All of the 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.


image5

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


Files to Bring to First Appointment

1 Consent to treat (pdf)

Download

1 Consent-to-Communicate via E-mail (pdf)

Download

1 HIPAA Notice Privacy Practices (pdf)

Download

1 History form - Infant (pdf)

Download

1 History form - Youth.Teen (pdf)

Download

1 Patient Registration Form (pdf)

Download

1 Patient Rights (pdf)

Download