Forms

Insurance Information

We are accepting new patients and take most insurances including Medicare, Aetna, Blue Cross and Blue Shield, United Healthcare, Alliant PPO and Tricare. This is not an all inclusive list. At this time, we DO NOT accept Ambetter, Caresource Medicaid, First Health, Clearspring PPO, and GA Cigna Connect. This is not an all inclusive list. We recommend that you call your insurance provider before your appointment with us in order to verify that we are in network with your provider. 

Forms

Patient Registration Portal

Begin your journey to optimal foot health by completing our Patient Registration Form, paving the way for personalized care
and a seamless experience at Chateau Foot & Ankle.

Release of Medical Records

Authorize seamless information sharing with our Release of Medical Records Form, facilitating communication and ensuring comprehensive care continuity at Chateau Foot & Ankle. Your health, your choice.

Minor Consent Form

Prioritize family care with our Minor Consent Form, ensuring a secure and informed treatment environment for minors at Chateau Foot & Ankle. Building trust, one family at a time.

HIPPA Privacy Policy

Safeguarding your privacy is our priority. Explore the details of our HIPAA Privacy Policy to ensure the confidentiality and security of your personal health information at Chateau Foot & Ankle.

Telemedicine Visits

Patients can now make telemedicine appointments with our office. If you have a telemedicine appointment, or would like to make one, please follow the link:
https://forms.myupdox.com/form/80703

Examples of appropriate Telemedicine Visits would be heel pain, ingrown toenails, gout flares, follow up questions from previous visit, shoe gear recommendations, test result follow-ups. You may be asked to make a follow up appointment in our office for imaging and thorough examination due to the inherent limitations of a telemedicine visit. 

Schedule Your Appointment Today!