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West Campus Foot & Ankle Clinic
33801 1st Way South, Suite 105, Federal Way, WA 98003 Tel 2538388377 Fax 2538389474PATIENT REGISTRATIONPatient Name:DOB:Address:
City:State:Employer:
Spouse Name:Zip:Homework
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How to fill out west campus foot and
How to fill out west campus foot and
01
Obtain the West Campus Foot and Ankle Brace form from the healthcare provider.
02
Fill out the patient information section, including name, date of birth, and contact information.
03
Provide details of the foot or ankle injury, including symptoms, date of onset, and any previous treatment.
04
Indicate any medical conditions or allergies that may affect the use of the brace.
05
Sign and date the form, acknowledging that the information provided is accurate.
Who needs west campus foot and?
01
Individuals who have sustained a foot or ankle injury
02
Those who require additional support or stability for their foot or ankle
03
Patients who have been prescribed a foot and ankle brace by a healthcare provider
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