Paul D. Brooks, DPM, P.A.

Thank you

for choosing us as your Foot and Ankle Specialist! 

New Patients Forms or change of information:

Patient Registration Form - Please complete this form and bring with you to your appointment.

Privacy Practice Form - Please list all persons whom you give permission to have us speak to on your behalf. Anyone not on this list, including spouses, cannot inquire about you without having their name listed on this form. Please view our HIPAA Privacy Practice before signing the acknowledgement form.

Medication List Form - Please use this form to list all your current medications.

*Please remember to bring a copy of a photo ID, insurance cards, and a list of your current medications.*

HIPAA Forms:

Notice of Privacy Practices - Our HIPAA policy.

Right to Inspect Form - You may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information.

Request of Restrictions Form - You may request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices.

Health Record Amendment Form- You may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment

Complaint Form - If you believe your privacy rights have been violated, you can file a complaint using this form. 

New Patients

Please click on the form names to access the document. You can then fill in the requested information, print the form and bring with you to your appointment.

Files are in Abobe Reader format. If you do not have Adobe, please click here to download your free copy.