Hi there and welcome to the PPFAC Forms page. If you are soon to be coming in to our office for your first appointment, please click on this link to download and print your New Patient Forms:
If your child will be coming in for their first appointment, please click here to also download and print the pediatric form. Both this and the New Patient form are needed at your son or daughters first appointment.
In addition, if you are an athlete, please also click to download and print the following athlete form.
Other forms that you may be looking for are found below:
If you have any questions regarding our Patient Forms please call us at (630) 834-3668.
If you'd like to fax forms or referral information to us, please fax to: (833) 220-0155.
Also note: To be sure all new patients have enough time to be fully examined and to allow discussion on any concerns, new patient appointments are scheduled for 20 minutes. There are some cases when the appointment may be finished sooner, but that allows plenty of patient care at your first visit. After checking in at the front desk, the medical assistant will escort you to the treatment room and review your medical history and get a description of your concerns. The doctor will then examine your foot/ankle and if necessary order the MA to get X-Rays. After full examination, the doctor will discuss your condition and treatment plan to get you back on your feet!
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Pediatric New Patient Packet Pediatric New Patient Packet for Prairie Path Foot & Ankle Clinic
School Sport Injury Claim Form to be completed prior to being seen by a physician at Prairie Path Foot & Ankle Clinic for a school sport related injury.
Worker's Compensation Form Worker's Compensation Form to be filled out prior to being seen by a physician at Prairie Path Foot & Ankle Clinic
Request for Second Opinion Patient Form Request for Second Opinion Form - Prairie Path Foot & Ankle Clinic
- Posted on 04/03/2020 New Patient Paperwork for Prairie Path Foot & Ankle Clinic
- Posted on 01/08/2020 PPFAC - HIPAA
- Posted on 08/13/2019 Pediatric New Patient Packet