550 S. Cleveland Ave.
5060 Bradenton Ave.
New Patient Forms
Dr. Jack Buchan
Dr. David Buchan
Dr. Randall Contento
Board Certified Foot
& Ankle Surgery
Fellow, American College of Foot and Ankle
As a new patient to Central Ohio Podiatry Group, you will be asked to complete the new patient forms below. Insurance companies also require any patient who has not been seen in the past 12 months to also complete these forms.
COPG New Patient Forms
Please print these forms by clicking on the link above and completely filling them out. Bring these three completed forms as well as your insurance card to your appointment. A copy of your current medications and allergies, if extensive, would be helpful.
You will be required to pay your co-payment when you arrive at the office. No services will be rendered if you do not have both your current insurance card and your co-payment. We accept payment in the form of cash, check, or credit card. Returned checks will be subject to a $30.00 return fee. It is your responsibility to verify our participation with your insurance plan and that of any ancillary providers prior to your visit. Minors, under 18, by law, must be accompanied by an adult.
If you are unable to print these forms, please call our office and we will be happy to mail them to you. You can also choose to come 15 minutes prior to your appointment to fill them out.
We look forward to serving your foot care needs. If you have any questions, please call 614-890-7224.
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