Client Forms

Easy Forms for your Footwear Appointment

Here are some common forms that may help you get services from us.

1. Althea’s Policy and Privacy Forms (PDF 733KB)

2. Patient Packet (PDF 735KB)
Print and complete these forms for your appointment.

3. Compression Stocking Prescription (PDF 287KB)
Print and take to your health care professional.

4. Diabetic Shoes & Inserts Prescription (Medicare) (PDF 239KB)
Print and take to the doctor who manages your diabetes. You must have a complete recent diabetic foot exam per Medicare.

5. Diabetic Shoes & Inserts Prescription (Non-Medicare) (PDF 178KB)
Print and take to your health care professional.

6. Orthopedic Shoes & Inserts Prescription (Non-Diabetic) (PDF 322KB)
Print and take to your health care professional.

7. Dshs Orthotic Prescription (Non-Diabetic) (PDF 228KB)
Print and take to your health care professional.

8. Instructions For Compression Stockings (PDF 210KB)
Print our instructions for proper fitting.

9. Instructions For Pedorthic Devices (PDF 271KB)
Print our instructions for proper fitting.

We are contracted with most insurance companies. Prior to your appointment, we strongly encourage you to contact your insurance company to verify coverage, deductibles and co-pays as not all insurance companies cover all services.

Please bring all insurance cards and completed prescriptions to your appointment.

If you have questions about the above forms, please email forms@altheas.net or call us at 425-303-0108.

1932 Broadway, Everett, WA 98201 | 7501 Custer Road West, Lakewood, WA 98499 | P2 Graphic Design