Intake Forms

As a time-saving feature, we have provided many of our forms in downloadable PDF format. You may download a free copy of Adobe Acrobat Reader.

As you call to schedule your appointment, our office staff can tell you which forms you’ll need. Completing the forms prior to coming to us will expedite your first visit.

Once they are filled out , you can email the form to humhandfoot@sbcglobal.net OR you can print the form and bring it to your first visit.

Individual printable forms found in the complete packet.

  1. Form HHFT Patient Registration
  2. Commercial Insurance Worksheet
  3. Medicare Insurance Worksheet
  4. Required Commercial Insurance Form
  5. Required Medicare Insurance Form 
  6. Form HHFT- Upper Extremity Quick Dash
  7. Form HHFT- Neck Pain Form
  8. Form HHFT- Low Back Pain Form
  9. Form HHFT- Lower Extremity Function Form 
  10. Wait List Availability  
  11. Wellness Program

Form HHFT Shoe List