FORMS

Therapeutic Shoes for Diabetes

 

New Patient Registration

Prescription

Permission to Release Medical Records (recent foot exam)

Permission to Release Medical Records (recent diabetes exam)

Statement of Certifying Physician

  1. The process starts with a foot exam and prescription.  

  2. Fill out the patient registration if you are a new patient.

  3. For fastest turn-around, request that recent clinical progress notes from both your foot exam and your diabetes exam be faxed to Boston Pedorthic at 270-747-8779.  Alternatively, you can click on each release above, fill it out, print and sign,  take a picture and then text them to 617-787-8779. 

  4. When we have received your documents, we will call you to schedule an appointment.