Patient Forms, Insurance, Billing, & Other Helpful Information

Downloadable Patient Forms

New Patient
Registration Packet

New Patient Registration Forms

We understand that your time is valuable and that filling out forms takes extra time. This is why we provide these forms on our website for you to download and complete before your appointment. By printing and filling them out before you get to our office, you can save time during check-in. Simply click the link above to open the forms. After they open, select the “print” button. Once you have the hard copies, fill them out completely and bring them with you to your appointment. You may also fax them to (814) 623-0561.


HIPAA stands for the federal Health Insurance Portability and Accountability Act, passed in 1996. The goal of this law is to make it easier for people to keep health insurance and to ensure the privacy and security of health information. The law also limits authority for the sharing of information, so you will need to be sure to sign the appropriate releases for your medical data for our office to obtain it from other doctors you see, or disclose your medical data to others.

Insurances Accepted

We are providers for most types of insurance that are offered in our area. Some examples include, but are not limited, Medicare, Blue Cross, Blue Shield, UPMC, Aetna, Cigna, United HealthCare, and worker’s compensation. We are not providers for Medicaid or any Medicaid products, Geisinger, or Gateway. If you do not see your insurance listed, please call the member services number on the back of your insurance card to see if we are providers, and to find out whether you need a referral for your visit.

Payment Options

Bedford Regional Foot & Ankle accepts cash, personal check, Visa, MasterCard, or Discover.

Billing Questions

If you have a question about a bill, please verify first that it is from our office. We cannot answer billing questions relating to physical therapy, pharmacy, hospital bills, or durable medical equipment (i.e., Breg). Our service bills patients according to insurance guidelines. Please contact your insurance prior to calling our office with billing questions.

Patients are responsible for all co-pays, co-insurance, and deductibles at the time of service. All co-pays are to be paid at the check-in window, with the receptionist. If you still have a billing question, please contact our office and your question will be forwarded to our billing service. All payments are due upon receipt of your statement.

What Patients Can Expect When They Visit Our Office

When you call to schedule your visit, we will ask for your name, date of birth, phone number, address, your insurance participation, your primary care physician, and whether you would like us to email, mail, fax, or if you would like to print your new patient paperwork from our website.

New patient visits take longer, so please know to schedule yourself up to 45 minutes with the doctor. We ask that you kindly arrive 15 minutes prior to your appointment time for your first visit. For subsequent visits, arriving ten minutes prior to the visit is fine. When you arrive, we will need your new patient paperwork that we have sent to you or you have printed from the website, referral if needed, a federally approved photo ID (ie: driver’s license, non-driver’s ID), your insurance card(s), and a list of your current medications. If you have a medicare replacement plan please bring your medicare insurance card as well to have on file.

If you have another person who has a medical or legal Power of Attorney, please bring paperwork so we may scan that into your file. You do not need to bring an original and all copies will be given back to person presenting them. If presenting with a minor, the parent that is the subscriber to the child’s insurance must bring their child unless special arrangements have been made prior to the office visit.

When you arrive, you will be greeted by the receptionist. We ask that you please sign in at the front desk and present your name and information. Please also give the receptionist any and all information that you have brought with you that you wish to share with the doctor for your evaluation. We will then ask for you to sign three or four documents. These include a permission to communicate information form, HIPPA acknowledgment, photo consent and cancellation policy form, and if appropriate and Advanced Beneficiary Notice from your insurance.

Once we have processed your paperwork and verified your insurance, we will escort you to a patient room and review any questions that arise from your intake information. The assistant will ask you to please state the reason you are coming to our facility and please include any and all concerns you have about your condition at that time.

The assistant will then ask if you need assistance taking off both shoes and socks if appropriate for the evaluation and treatment. You will be asked to sit in the exam chair while the assistant reviews with the doctor your concerns. The doctor has scheduled up to 45 minutes with you at your initial visit. During this time you may have x-rays taken as well, if it is necessary for your evaluation. While you are with the doctor, be certain to share your concerns and reasons for coming in that day. Towards the end of your visit, the doctor will review your treatment plan and give you instructions if necessary. He will also ask if you have any questions at that time.

We are always happy to answer your questions; however, we cannot guarantee, after the doctor has left the room, that he would have any additional time to review questions directly with the patient during the same visit. For instance, the doctor may be in with the next patient and you may need to leave a message with the receptionist at that point. We will make your next appointment while you are still in the exam room if you need to return.

At that time the assistant will further instruct you if you need to stop back at the front desk before you leave. At the front desk, we will give you copies of any prescriptions, instructions, educational information, etc. If you realize that you forgot to ask us anything during your visit, or you later have a question, please feel free to call our office.