We require completion of patient forms prior to your office visit.

 

Kindly fill out and sign the Podiatry New Patient Form, Release and Assignment, Privacy Practices Acknowledgement Form, and Consent for Treatment.  Additionally, please provide us with front and back copies of your primary and secondary insurance card(s).

 

 

You may return the completed Forms by any one of the following methods:

  • Electronically submit your forms to us (fastest way): Link

 

OR

 

  • Return the Forms by mail to:

 

Dr. Kamran D. Farahani

6929 N. Hayden Rd.

Suite C4-309

Scottsdale, AZ 85250

 

OR

 

  • Fax the Forms to: (480) 603-1814 or (718) 532-0347

 

OR

 

 

 

If you have any questions, please call at (480) 788-2524.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New Patient Forms

© 2014 Foot & Ankle Institute of Arizona, LLC 

Call us today:  (480) 788-2524

Ext. 1- House Call Visits

Ext. 2- In-Office Visits

Ext. 3- Medical Providers 

Ext. 4- Billing 

Ext. 0- General Info

Address: 4045 E. Union Hills Dr 

                Suite #107

                Phoenix, AZ 85050

Email: azfoot99@gmail.com

Fax:  (480) 603-1814 or (718) 532-0347 

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