Patient Info & Forms

Your First Appointment:

As there is paperwork to be filled out upon your first visit to Agoura-Los Robles Podiatry Centers, we ask you please arrive early, so that we can ensure the initial paperwork is completed.  Should it be easier for you, we have included the forms we need completed below.  Click on them to open the .pdf document, or right click and choose “Save Target As”, or “Save Links As”, to save the .pdf to your computer.  Once you open the .pdf please print it and fill it out as completely as possible.  Also, please bring the following:

  • Patient’s insurance card and driver’s license or another form of photo I.D.
  • List of current prescriptions and/or over-the-counter medication, including dosage and frequency
  • Information about patient’s medical and surgical history
  • Recent test results, x-rays, or relevant records

New Patient (first visit) forms to be completed by the patient:

Health History

Patient Info

HIPPA Privacy Form

 *Please note, some Apple users are unable to print these forms.  If this applies to you, please arrive 15 minutes early and fill them out in the office.