You may download and print these forms and present to your physician.
Forms shoud be filled out completely to reduce delays. Contact our office with any questions.
_____________________________________________________
Instructions for Diabetic Footwear
These forms are necessary for Diabetic footwear benefit through Medicare of Medicare advantage policies.
___________________________________________________________________
The following form is required by your Medicaid Benefit in it’s ORIGINAL form.
Fiscal Order for NYS Medicaid Benefit
____________________________________________________________________
Foot Performance Order form for Physicians -
RX healing shoes, compression hose
Document of Medical Necessity for Ankle Foot Orthotics
____________________________________________________________
Medicare required documents for patient’s
