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New patient forms referral printable for podiatry

New patient forms referral printable for podiatry 2026

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The document is a standard referral form for diabetic patients requiring podiatry services at Carmarthenshire NHS Trust. It includes sections for patient information, medical history, vascular and neurological assessments, foot examination details, and risk assessment for diabetic foot pathology. The form aims to facilitate communication between general practitioners and the Podiatry Department.

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Click ‘Get Form’ to open the new patient forms referral printable for podiatry in our editor.
Begin by entering the patient's name, GP/Surgery, and address in the designated fields. Ensure accuracy as this information is crucial for proper identification.
Fill in the date of birth (DOB) and details of the hospital or consultant. This helps streamline communication between healthcare providers.
Provide a contact phone number for follow-up purposes. This should be a reliable number where the patient can be reached.
In the 'History' section, indicate any previous ulcerations, amputations, or vascular assessments by selecting 'Yes' or 'No' as applicable.
Complete the neurological assessment fields, including results from tests like the 10g monofilament test and vibration perception threshold.
Document findings from the foot examination, noting any pathological callous or nail conditions on both left and right feet.
Finally, summarize the patient's risk level regarding diabetic foot pathology and add any additional comments in the provided space.

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When should you refer a patient to a podiatrist?

You should see a podiatrist if you feel pain or have problems with your feet, ankles or lower limbs such as discoloured skin/nails, skin rashes, foot odour, foot ulcers or foot injuries. It is also good to see a podiatrist if you have diabetes, arthritis or tripping and falling issues.

What is the average cost to see a podiatrist?

Cost of podiatrist visit by state StateNameAverage Cash Price California $90 - $135 Colorado $80 - $118 Connecticut $87 - $130 Delaware $85 - $12647 more rows

Do I need a referral to see a podiatrist?

In most cases, you can go straight to a podiatrist without a referral. This direct access allows for prompt, specialized care for your foot and ankle concerns. However, its essential to check with your insurance provider to understand any coverage requirements.

How to create a patient form?

Essential Information to Include in a Patient Registration Form Personal Information. Full Name (First and Last Name) Emergency Contact Information. Emergency Contact Name. Medical History Current Health Status. Existing Medical Conditions. Insurance and Payment Information. Appointment Preferences. Terms and Agreements.

What forms are required for new patients?

Request the necessary insurance data and a photo identification when you provide the patient with the standard new patient forms, typically the health history form, a declaration of the practices payment policy, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) forms, etc.

What foot conditions need to be referred to the podiatrist?

Bunions. Plantar warts. Foot and ankle arthritis. Skin conditions affecting your feet and toenails.

Is it better to go to a podiatrist or the Good feet store?

The Bottom Line: Invest in What Works Proper diagnosis and custom orthotics made specifically for the individual are far more effective than the products sold at The Good Feet Store.

How to get a referral for a podiatrist?

Having worked in the medical field for 18 years, a personal recommendation from a trusted family member or friend who is under the care of a podiatrist is the best way to go. If not, a recommendation by your primary care doctor or another doctor you see on a regular basis. Google would be a last resort.