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Overview

New patients must complete the New Patient Registration Packet

Also, take a look at the “Your First Visit" page

Established patients:

complete all forms if it has been more than one year since you have been to the office.

Everyone:

Note the optional Sports Medicine Form.


Description of Patient Forms

New Patient Registration

#1 Patient Contact & Insurance Information - Also use this separately if at any time your insurance changes, or you move or make other changes .

#2 Consents and Policy Agreements

#3 Podiatric History Information - Use this separately if coming to the office as a return patient months or years later. For example, you first are seen for an infected ingrown toenail. Months, or ayear later, you develop heel pain, or hurt yourself. If your insurance has not changed, and no medication changes, then this is all you need to fill out.

#4 Medical History Information

#5 Privacy Statement Signature Sheet - Note, you only need to bring to summary sheet is for your own use / file; and the complete form is available under the optional file documents listed below.

#6 Optional Sports Medicine History Form

Anyone can complete this form who walks, runs or otherwise exercises on their feet regularly. It is not required if you are, for example, coming in to have an ingrown nail or wart taken care of for your first visit. However, if you have the time, still do it.

Definitely complete this if you are coming in to have a pain or condition evaluated that is not visible externally , even if your pain is not , for example, associated with running, but is noted at another time of the day.

With each new injury over the years, completing this form with new information will be beneficial

#7 Records Release Forms

#8 Optional Forms For Reviews

YOU ARE WELCOME TO DO TWO SIDED PRINTING TO SAVE PAPER.


The documents listed below are for your review, but are not needed for any appointment:

Notice of nondiscrimination in delivery of health care

Entire privacy statement literature

Product standards

Contact Us Today

Our Location

Find us on the map

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Dr Larry Assalita's office is in Scenery Park

110 Regent Court, Suite 200
We are adjacent to the elevator, top floor ( level 2 )

Enter through the side of the building that faces Atherton Street ( right photo above ) for Elevator Access.
Park outside, not under the building ( those covered spaces are reserved and your car would be towed )

Office Hours

Our Regular Schedule

Monday:

8:00 am-4:30 pm

Tuesday:

8:00 am-4:30 pm

Wednesday:

8:00 am-4:30 pm

Thursday:

8:00 am-4:30 pm

Friday:

8:00 am to Noon

Saturday:

Closed

Sunday:

Closed