FDFAC New Patient Registration

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FDFAC Policies

As a convenience, Financial District Foot & Ankle Center will bill your insurance company for fees and services. Information received by your insurance company does not pre-authorize payment. In order to receive benefits, the member must be covered at the time of service. The benefits information received by FDFAC is not all-inclusive. It is limited to some coverage highlights. Other terms and limitations may apply even though such provisions are not indicated by your insurance provider. All claims are subject to medical review, (by your insurance provider), according to the information submitted by the provider of the service and are subject to benefit maximums and other terms of the member's contract. Please refer to your applicable benefit agreements to determine the appropriate payment amounts and any limitations or exclusions.

FDFAC contracts with an outside billing company, (Computer Billing Services), to handle all billing and insurance payment questions.

FDFAC is not a HMO Contractor, a Workers Comp Provider, a participant of Covered California or any equivalent. FDFAC does not have a contractual relationship with the entities mentioned in this paragraph.

Assignment of Benefits: I hereby assign payment directly to Financial District Foot & Ankle Center, the insurance benefits otherwise payable to me. I understand that I am financially responsible for the charges not covered by this authorization. I also authorize a photocopy of this assignment as if it were an original copy. If it becomes necessary for the account to be referred to an attorney for collection or suit, the undersigned shall pay the reasonable attorney’s fee and collection expenses. Further, I understand that coinsurance, unsatisfied deductible amounts, etc. are requested at the time of services unless other financial arrangements are made in advance.

This page serves to inform you of the privacy practices of Financial District Foot & Ankle Center and its representatives. The privacy of your medical information is important to us. We intend to honor your privacy in every way possible.

By clicking the check box below you will allow us to disclose your personal health information:

  • For treatment of your medical condition
  • For help in attaining the maximum benefits allowed by your insurance company
  • To any 3rd party representatives also working in the treatment of your medical diagnosis
  • By Superior or Federal Court Subpoena
  • We respect your rights in maintaining the utmost in privacy in regards to your individual health information. We will not release any of your health information to non-medical entities without your prior written permission

Financial District Foot & Ankle Center maintains physical and electronic safeguards that restrict unauthorized access to your health information. Such safeguards include secured office facilities, locked file cabinets and controlled computer network systems and password accounts.

We will only disclose your medical information to your health plan or other health care professionals or facilities for purposes of diagnosis or treatment of your medical condition. If you prefer that we do not disclose any or all of your medical condition(s), please inform us so that we may take any necessary precautions.


Doctors of Podiatric Medicine are licensed and regulated by the Medical Board of California.
(800) 633-2322

Late Cancellation/Reschedule Fee (Within Two Business Days of Appointment, Monday - Thursday):

We understand that unplanned issues come up, and that sometimes you will need to cancel and/or reschedule appointments. However, if you are unable to keep an appointment, we ask that you call our office at least 2 business days in advance -- so that your appointment time can be made available to other patients who require care.

Individuals who cancel or reschedule an appointment with less than two business days notice (or who fail to show up for a scheduled exam) may incur a fee equal to the fee of the appointment being canceled or rescheduled. Similarly, individuals who arrive so late that an examination cannot begin without disturbing another patient's regularly scheduled appointment will also be charged a cancellation/reschedule fee.

Repeated late cancellations or no-show appointments will require non-refundable deposit, and may result in your being referred to another medical practice for services.