Patient Registration

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New Patient Information

Insurance Information

  • Please present your insurance cards and Photo I.D ( A copy will become part of your medical record)

Foot Health History

  • I authorize the release of any medical or other information necessary to process my insurance claims. I also request payment of benefits either to myself or to the party who accepts assignments. I authorize payment of medical benefits to Dr. Griffin or any other supplier for services rendered to me. I authorize the release of Medical Information shared from primary care physician to Dr. Griffin and authorized staff for medical purposes.