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

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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.

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