Patient Information

At Agoura-Los Robles Podiatry Centers we would like to keep our patients as informed as possible...

so we will be posting regular content ranging from medical terminology, to podiatric articles on the internet,  to forms patients might need when coming to our office.  Below we have listed a few things regarding your first visit to our practice, or a returning visit after you have not been to see us in awhile.

 

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 two 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 Information

 

Return Visit:

Once a year we will need you to fill out an updated health history form informing us of any changes or additions to your medical records.  Each of our three podiatrists have differing forms, so please take note of who is your doctor and click on the corresponding form below.  As with the documents above, you can click on the .pdf file to open it, or right click and choose “Save Target As”, or “Save Link As”, to save a copy to your computer.  Once the .pdf is open, print it, and then complete the form as best you can.

Dr. Stephen Benson, DPM Dr. Darren Payne, DPM Dr. Michael Zapf, DPM