PATIENT INFORMATION
PATIENT INTAKE FORMS
Your journey with Freedom Prosthetics & Orthotics starts with us getting to know you. To make the process easier, you can either submit your initial paperwork electronically or print the forms and bring them to your first evaluation. Simply click on the “New Patient Intake Form” to download and complete the necessary paperwork.
ELECTRONIC SUBMISSION
We also offer a form that you can complete, print out, and either bring with you or email to our documentation specialist: kylie@freedompo.net
Be ready for your first visit!
What to Bring to Your First Appointment:
Valid Photo ID
Insurance Card (s)
Prescription
Orthotics: Bring the shoes you wear on a daily basis
Prosthetics: Please wear clothing that will allow us to easily access your prosthetic. We do provide disposable shorts if needed.
For a list of insurances we are in-network with, click here
Do you have questions? We have answers! See our Frequently Asked Questions for help.
Click here to view to view our COVID NOTICE.
NEED FURTHER ASSISTANCE?
PROSTHETIC RESOURCES
Prosthetic Care Guide English Spanish
Amputee Support Group
ORTHOTIC RESOURCES
ST. GEORGE LOCATION
Mon-Thurs: 9:00am - 4:30pm
Friday: By Appointment
Home Visits Upon Request
CEDAR CITY LOCATION
By Appointment Only
Home Visits Upon Request