2404 N. Courtenay Parkway
Merritt Island, Florida 32953
Welcome to Merritt Island Foot and Ankle in Merritt Island & Melbourne, FL
Patient's Health Insurance Card(s)
Primary Care Doctor's name and telephone number
Referral From Your Primary Care Doctor (If Required By Your Insurance Carrier)
List of current prescriptions and/or over-the-counter medication, including dose and frequency
Information about patient's medical and surgical history
Any Previous X-Rays, MRIs or Test Results Relating To Any Past Foot Health Conditions
If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours notice. We ask for this advance notice so that we can offer this appointment to another patient. A fee may be charged if a patient does not show up for an appointment without sufficient notice.
Click on the button below to download the convenient PDF fillable form to be completed for your visit. Fill out the form in its entirety. Please note: you will need Free Adobe Acrobat Reader or Preview on a Mac to view and type into this form,
You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please call our office (321) 452-1327. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.
Insurances we accept as of 01/01/2022
BCBS (and BCBS MCR replacements)
BCBS HMO (and BCBS MCR replacements)
Cigna (and Cigna MCR replacements)
Florida Health Care Plan
Tricare (Select Standard and Prime)
United Health Care
Workers Compensation (In State Only)
We will be more than happy to submit all insurance forms for you and help you recover the most from your benefits. We will do everything we can to help you afford the treatment you need and want. For patients who require major work, a complete payment plan is designed with an appropriate payment schedule. Forms of payment accepted by the office are check, cash, or any major credit card.