For your convenience, we have provided the essential forms online to help expedite your initial visit to the office. The forms can be downloaded and printed at your convenience. If possible, please complete them prior to your initial visit to the office. If you have any questions, please contact the office at (314) 726 – 2377
Patient Information Sheet *
This form is used to gather important demographic and insurance information that will be required at the initial office visit. The information will be placed in your file for future reference and verified at each subsequent visit.
Records Release Form
This form is used to give Medical West Podiatry authority to release your medical record and its information to other requesting entities. This form also allows the office to request copies of your health/medical records from other entities—this is especially important for patients who transfer their care from other providers. You have the option to decline the release of your health information from this office—this will be noted in your medical chart.
Medical History Update
Financial Responsibility Form
*These forms are not needed at your initial visit