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Family Footcare

Family Footcare

  • About
    • About Family Footcare
    • Meet Our Expert Podiatrists & Foot Surgeons in CT
      • Meet Dr. James M. DeJesus, DPM, FACFAS, FACFO: Board Certified Foot Surgeon
      • Dr. Michelle DeJesus, DPM: Compassionate Podiatric Care
      • Meet Dr. Betty M. Carreira, DPM: Specialist in Foot Care
      • Meet Dr. Austin Davidow, DPM: Expert Podiatrist
    • Our Convenient Connecticut Office Locations
    • Newsletter
  • Patients
    • Patient Portal
    • Patient Forms
    • Online Bill Pay
    • Insurance Plans & Payment Options
  • Services
    • Treatment for Nail & Skin Conditions
    • Comprehensive Diabetic Foot Care & Monitoring
    • Sports Medicine: Injury Diagnosis & Treatment
    • Emergency Foot & Ankle Trauma Services
    • Comprehensive Diagnosis & Relief for Foot Pain
    • Regenerative Stem Cell Therapy
  • Surgery
    • Accredited Surgical Facilities & Safety Standards
    • Bunion & Hammertoe Correction Specialists
    • Advanced Peripheral Nerve Surgery
    • Surgical Tendon Repair & Fracture Management
    • Reconstructive Foot & Ankle Surgery
    • Post-Operative Care & Recovery Instructions
  • Diagnostics
    • Diagnostic Musculoskeletal Ultrasound
    • Advanced Digital X-Ray & Diagnostic Imaging
    • Diagnostic Skin Biopsy & Pathology
  • Products
    • Topical Skin & Nail Treatment
    • Peripheral Nerve Restoration Therapy
    • Clinical-Grade Nutraceuticals & Supplements
    • Advanced Wound Care & Ulcer Treatment
    • Custom Arch Support & Orthotic Solutions
    • Therapeutic Diabetic Shoes & Custom Fittings
  • Contact

Patient Forms

Download Patient Forms to Save Time at Appointments

 

To provide you with the best possible care, Family Footcare needs to gather important information about your medical history and current physical condition. We also need to keep emergency contacts and insurance information up-to-date.

For your convenience, all our forms are available in one PDF. Use the link below to download the PDF file. You may print and complete them before your arrival and hand your completed forms to the receptionist when you check in for your appointment. You may also obtain and complete the forms at our offices; in this case, please arrive 15 minutes early to allow time to complete the forms before your scheduled appointment time.

We look forward to seeing you!
Family Footcare staff


New Patients Forms

These forms are for new patients. Please download PDF, complete all forms, and bring it to your appointment along with your insurance card and photo ID. 
Download Form


Notice of Privacy Practices 

Download PDF, no signature required, Family Footcare’s privacy practice policy. 
Download Form


2023 Patient Update Form

This form is for existing patients and is not intended for new patient use.
Download Form

Primary Sidebar

About

  • About Family Footcare
  • Meet Our Expert Podiatrists & Foot Surgeons in CT
  • Meet Dr. James M. DeJesus, DPM, FACFAS, FACFO: Board Certified Foot Surgeon
  • Dr. Michelle DeJesus, DPM: Compassionate Podiatric Care
  • Meet Dr. Betty M. Carreira, DPM: Specialist in Foot Care
  • Meet Dr. Austin Davidow, DPM: Expert Podiatrist
  • Insurance Plans & Payment Options
  • Patient Forms
  • Our Convenient Connecticut Office Locations

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Foot Massages for Relieving Foot Pain

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Family Footcare logo
  • (203) 723-7884  • 1183 New Haven Road Naugatuck, CT 06770
  • (203) 792-3668 • 52 Federal Road Danbury, CT 06810
  • (203) 405-6501 • 77 Main Street North St. 104 Southbury, CT 06488
Family Footcare logo
  • (203) 723-7884 
  • 1183 New Haven Road,
    Naugatuck, CT 06770
  • (203) 729-3668 
  • 52 Federal Road,
    Danbury, CT 06810
  • (203) 405-6501 
  • 77 Main Street North St. 104
    Southbury, CT 06488

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