Call us directly: 304-699-2373

2601 Dudley Ave. Ste 5A, Parkersburg, WV 26101 View Location

2354 Richmiller Lane, Belpre, OH 45714 View Location

Patient Forms

In your initial visit, we will have you read the following forms, and provide a digital signature validating your review.

1. Medicare Supplier Standards
2. Notice of Privacy Practices
3. Consent for the Use and Disclosure of Protected Health Information
4. Release & Consent Form
5. Protocol for Resolving Complaints from Medicare Beneficiaries

You will also need to fill out the following forms. Feel free to print and fill out in advance.
1. Patient Information Form
2. Medical History
3. Prosthetic History (if you have limb loss)