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Transfer of Records Request Form
If you have previously seen a podiatrist and are transferring to Texoma Foot and Ankle Specialists, please complete the Transfer of Records Request form and return it to our office in-person, by fax to 833-974-2040 (Denison) or 833-303-0126 (Anna) or by email to TexomaFoot@stridecare.com. We will send the form to your previous podiatrist to obtain your previous records and avoid unnecessary duplication of procedures or treatments.Transfer of Records Request Form
Patient Records Request Form
In accordance with HIPAA regulations, patients may request copies of their records as needed. We do require 72 hours advance notice to process your request, and a fee may be required before documents are released. Please complete the Patient Records Request form and return it to our office in-person, by fax to 833-974-2040 (Denison) or 833-303-0126 (Anna) or by email to TexomaFoot@stridecare.com. This form can also be used to request a copy of records to be released to a third party; please designate the recipient in the appropriate area of the form. If you only wish to review your medical chart without obtaining a copy to release, you may do so free of charge by scheduling a time with our office biller.Patient Records Request Form
Minor Child Consent Form
If your child (younger than 18 years old) will be coming to an appointment without the legal parent/ guardian but in the care of another adult, such as a friend or grandparent, please complete the Minor Child Consent Form designating another adult as able to make medical decisions in your absence. You, as the legal guardian or parent, will need to complete and sign the form. This form can be faxed to our office at 833-974-2040 (Denison) or 833-303-0126 (Anna) before the visit or brought in by the adult accompanying your minor child at the time of the appointment. You may also email the form to TexomaFoot@stridecare.com.Minor Child Consent Form