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New Patient Forms
We ask that new and established patients complete the FAANT Forms below each year or earlier if there are changes.Click on the title of each form below to download them.
All patients should complete the first 5 pages: 1. Registration, 2. Consent, 3. Policies, 4. Past History, 5. Current History. In addition Medicare patients should also complete page 6, the Medicare Screening for Coordination of Benefits. And anyone under 18 should have their guardian complete the Minor Authorization form.
The requested forms should then be submitted to our office 48 hours prior to your appointment, via our secure fax at 817-886-3612. This will help us update your record and expedite your visit.
Please call our business team if you have any questions regarding these forms, or need the Spanish version of these forms at 817-416-6155.
1. Patient Registration Form
2. Patient Authorized Consent
3. Office Policies and Procedures Form
4. Medical Past History Form
5. Current Medical History Form
6. Only Medicare Patients Screening Form
7. Authorization to Treat a Minor Form
8. HIPAA Disclosure
9. These Are the Insurances That We Currently Accept List
10. What is a FAANT-astic Visit?
11. Grapevine Area Map
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Foot and Ankle Associates of North Texas, LLP
2421 Ira E Woods Ave, Suite 100
Grapevine, Texas 76051
Phone: 817-416-6155
Fax: 817-329-9434
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Healthy Steps
2421 Ira E Woods Ave, Suite 100
Grapevine, Texas 76051
Phone: 817-796-3262
Get Directions