Download Initial Registration

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PATIENT REGISTRATION

English
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To download registration, right click on above image and choose "save link as"

1. Download Initial Registration
2. Please answer all questions (highlighted in yellow)
3. Upon answering all question (highlighted in yellow) “PRINT FORMS”
4. After printing forms please Sing, Date and Print name on page 4

Options for sending signed and dated forms to West Beverly Podiatry Group, Inc

5. Signed and dated forms can be scanned into computer and sent as an attachment via E-mail info@wbpgfoot.com
6. Signed and dated forms can be sent Via Fax 323-887-1891
7. Signed and dated forms can be sent via US post office (snail mail) 1417 West Beverly Blvd., Suite
104 Montebello, CA 90640