Welcome to our practice and the world’s first iDoc™ Digital Medical Practice. The system you will be using does not require paper, and uses the iPad as your interface. Use this device just like your computer. Here are some basic tips:

  • Touch the checkboxes to check or uncheck them.
  • Tap the text box to get the cursor to activate, and then use the keyboard that pops up to type your response.
  • Make sure to follow the instructions on each section before you complete it.
  • Tap the Submit button on the bottom to send your form to our network and advise the staff that you are done.
  • You can hold on to your iPad and press the center button to get to the home menu.  Use the Pad to browse the web, read your email, or read magazines that are included while you wait for your visit.
  • One of the front office staff will come and greet you when your chart is ready.

Before we begin your experience and provide you with the best foot surgery has to offer, we need to collect some information from you.

I have always respected privacy as the most important value of any information system. Even though there are laws that govern medical privacy, I want to give you my personal guarantee, that all the information you provide my practice, will protected and never shared, in any form, with any entity unless you give us permission. – Dr. Ali Sadrieh

Now sit back and enjoy the future of health care.  Scroll down the page to see and complete each form.  Once you see the confirmation that your form was sent, scroll down to then next form.

Please complete all the patient information documents and when you are done, let one of our staff members know and they will guide you to your consultation room so you can meet the doctor.

We respect your choosing our practice as the solution for your concerns with your feet… welcome.

Form 1 of 3 | New Patient Information

Patient's First Name (required)                    Patient's Last Name (required)

Patient's Social Security Number (required)
 -  - 


Patient's Address (required)
Number   Street Name   Apt 

City   State   Country (if not U.S.)   Zip 


Patient's Date of Birth (required)

Month   Date   Year

Patient's Sex
 Male Female

Patient's Marital Status
 Single Married Divorced Separated

Primary Phone Number (required)
 -  -   Mobile Home Work


Secondary Phone Number
 -  -   Mobile Home Work


Other Phone Number
 -  -   Mobile Home Work


Email Address (will not be shared) (required)

If you are the patient, are you currently employed?
 Yes No
If yes, who is your employer?

What is your occupation?

How did you find out about us? (required)

If you answered Physician or Patient in the previous question, please specify so we can thank them

Is the patient the financially or legally responsible party? (required)
 Yes No

If you answered No to the previous question, indicate Your relationship to the patient, and continue to complete Form 2

Form 2 of 3 | Responsible Party Information

Guardian's First Name (required)                 Guardian's Last Name (required)

Guardian's Social Security Number (required)
 -  - 


Guardian's Address (required)
Number   Street Name   Apt 

City   State   Country (if not U.S.)   Zip 


Guardian's Date of Birth (required)

Month   Date   Year

Guardian's Sex
 Male Female

Guardian's Marital Status
 Single Married Divorced Separated

Primary Phone Number (required)
 -  -   Mobile Home Work


Secondary Phone Number
 -  -   Mobile Home Work


Other Phone Number
 -  -   Mobile Home Work


Email Address (will not be shared) (required)

Are you currently employed?
 Yes No
If yes, who is your employer?

What is your occupation?

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Form 3 of 3 | Insurance Information

Do you or the patient have health insurance? (required)
 Yes No

If no, who will be billed for the services provided by our practice? (required)

Primary Insurance Company

Name Phone Number - -

Policy No. Group No. Subscriber ID 

Secondary Insurance Company

Name Phone Number - -

Policy No. Group No. Subscriber ID