Your first visit to Foot & Ankle Center of Illinois establishes a vital foundation for our relationship with you.
We are privileged to serve you and committed to providing you with excellent medical care and service. During the first visit, we need to obtain important background information to establish your electronic medical record. In order to streamline this process, please complete the enclosed forms in advance and give them to our receptionist when you arrive for your appointment.
Our practice will work with you to relieve your pain and discomfort and to maximize your full function as soon as possible. Our goal is to heal, restore, and rejuvenate your quality of life. We are committed to exceed your expectations and will strive to continuously improve on all levels for your benefit.
NEW PATIENTS PLEASE COMPLETE THE FOLLOWING:
- HEALTH HISTORY QUESTIONNAIRE [PDF] [Online]
- RECEIPT OF PRIVACY PRACTICES [PDF] [Online]
- FINANCIAL POLICY [PDF] [Online]
- PRIVACY PAMPHLET [PDF]
- AUTHORIZATION TO RELEASE INFORMATION [PDF] [Online]
- WORKERS' COMPENSATION FORM [PDF] [Online]
Please feel free to call us if you have any questions. Thank you in advance for choosing us and helping us streamline your registration. My staff and I look forward to meeting you!
THE FOOT & ANKLE CENTER OF ILLINOIS IS ACCEPTING ALL BLUE CROSS & BLUE SHIELD INSURANCE PLANS, ALL STATE EMPLOYEE INSURANCE PLANS, AND SMALL BUSINESS INSURANCE PLANS.
INSURANCE AND BILLING:
Our office accepts these primary insurance plans, and more:
PHAI BCBS HMO
Personal Care HMO/PPO
United Healthcare HMO/PPO
Blue Cross Blue Shield HMO/PPO
Health Alliance -Select Plans (Springfield & Decatur)