New Patient Paperwork

NEW TO PRIMERA?

We accept most major medical insurance plans including Medicare, Blue Cross, Aetna, Cigna, United Healthcare, and many more. If you have a question about your specific plan, we are happy to assist you. Click here to Contact Us.

> ABN Form

> Primera New Patient prednisone Information Form

> Financial Responsibility Form

> HIPPA

> Medical History Form

> Latex Allergy Form

> Medicare Assignment

> Medicare Nail Care Form

Request an Appointment

First & Last Name*
Date of Birth*
Phone Number*
Email Address*
Office Location*
Reason for your Visit*
Appointment Date*

We are a fully integrated medical practice that specializes in medical and surgical treatment for foot and ankle problems.