New Patient Forms
We require completion of patient forms prior to the doctor's home 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 copes of your primary and secondary insurance card(s).
Credit Card Authorization Form -- Patients with Copays ONLY (Form)
Return the Forms by mail to:
Dr. Kamran D. Farahani
6929 N. Hayden Rd.
Scottsdale, AZ 85250
Fax the Forms to: (480) 603-1814 or (718) 532-0347
If you have any questions, please call at (480) 788-2524.