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Manchester, CT 06040
Tel/Fax 1-888-804-7180


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Manchester Podiatry Center, P.C.

Practice of Podiatric Medicine

Patient Information

Download, review, and complete our patient forms:
Patient Information (4 pages)*
Notice of Privacy Practice* optional
Medicare Private Contract*

Authorization for Release of Information* - only needed if you request transfer of records.

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1-888-804-7180

Manchester, CT 06040

Patient Information

Patient Forms

Before Dr. Wichman arrives on the house call you can download, review, and complete the necessary forms:

Patient Information* (4 pages)
Notice of Privacy Practice* optional
Medicare Private Contract*

If you have any questions, you can ask them when Dr. Wichman arrives for the visit.

Authorization for Release of Information* - only needed if you request transfer of records.

 

*The form is in PDF format. If you cannot read the PDF, please download the free Adobe Acrobat Reader from the Adobe website.


The information provided on this website is not intended to be a substitute for medical attention, diagnosis or treatment, it is intended for informational purposes only. Specific questions should be directed to the visitor's health care provider.
Manchester Podiatry Center is not liable in any manner for the decisions of visitors whose actions are based on information found on this website.

©2017 Manchester Podiatry Center. All rights reserved.

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