Harford Lower Extremity Specialists
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New Patients

In order to serve you better and faster we have provided our New Patient Information Form online.

New patients, please complete and return your new patient registration forms at least 24 hours prior to your visit. You may fax or e-mail these so your electronic health record can be created prior to your arrival. Thank you for your cooperation.

Wound Care Patients, please complete the Wound Care Assessment Form prior to your visit.

We now accept forms by email or fax. Email completed forms to: forms@HLSfootcare.com or fax to: 410-836-8594

New Patient Forms:

Download Document
Format
New Patient Registration Form*
Wound Care Assessment Form*
Statement Free Green Office, PLEASE read the credit authorization and complete*
Notice of Privacy Practices*

*You must have an Acrobat Reader to view the Acrobat files. If you don't already have Adobe Acrobat, you can download the Acrobat Reader Free.

Care Credit

CareCredit is a personal line of credit for healthcare treatments and procedures for your entire family. It is a credit card but it has two advantages. It can only be used for healthcare services and you can get No Interest if paid in full within the promotional period* on purchases made with your CareCredit card.

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Referral Rewards Program



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