I hereby authorize Dr Schatz to the biomechanical assessment, gait analysis, casting procedures, techniques and clinical photographs/video that the pedorthist deem necessary for my care.
I understand that prior to any diagnostic procedure, technique or any clinical pictures or video, I will be advised by the pedorthist, and may ask any questions concerning treatment. I also understand that foot orthosis work in conjunction with proper footwear and agree to any recommendations made by the pedorthist.
I hereby authorize and consent to Dr Peter Schatz to release to insurance carriers or others that are financially liable for pedorthic care, any information needed to substantiate payment for such care. After records have been released, these cannot be revoked retroactively to cover information prior to revocation.
I have read and understand the consent form, and have been given the
opportunity to ask questions I might have, and my questions have been answered in a satisfactory manner.
