Monday, Tuesday & Thursday 9am to 5pm - Friday 1pm to 5pm

  • 972.542.FOOT (3668)

Forms

Patient Registration

Patient Registration must be completed for all new patients AND any patient that we have not seen in 3 or more years.

Other Forms

These forms are optional and are not required for new patient registration.  Only complete these forms if needed.

Authorization to Treat Minor in the Absence of Parent or Legal Guardian

Complete this form if the parent or legal guardian cannot accompany any patient under the age of 18.  Some procedures, including new patient visits, will require the parent or legal guardian to accompany the patient.  The person accompanying the patient will be required to provide proof if of identification with a drivers license or other photo ID.

Medical Records Request

Complete this form to release some or all of your medical records to yourself or another physician

Medical Records Request - Other Office

Complete this form request medical records FROM another physician's office TO McKinney Foot Care.
Please note that other physician's offices may have their own form they would like you to use.

FMLA or Disability Paperwork Request

If your employer requires paperwork to be completed by our office, please complete the attached form and fax it, along with your employer's paperwork, to 972-542-1728.
Allow 72 hours for the paperwork to be completed.  If you're preparing a leave due to upcoming surgery, you must have these form to our office 1 week prior to your surgery date.

Notice of Privacy Practices

Patient Financial Responsibility Policy