Two forms important for all patients attending ACT Podiatry include the:
New Patients Form – ACT Podiatry (Relevant to all patients) and the Foot Health Status Questionnaire Form (FHSQ)
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New Patient Registration Form - ACT Podiatry
It is useful for all patients attending ACT Podiatry to fill out the ‘New Patient Form’. This however is not critical as it can also be done on the day of your consultation. It simply saves you time on the day and you are able to see what we consider as important in your management.
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New Patient Registration Form - ACT Podiatry
The Foot Health Status Questionnaire (FHSQ) is a fully validated and reliable measurement tool, which can be used to measure quality of life outcomes for patients with foot and ankle disorders. In short it is an accurate method of determining a change in your foot health following a treatment, whether this be a non-surgical or surgical option. The FHSQ has four domains, which are used to assess a person’s perception of their level of pain, functional capacity, the general health of their foot (or feet), and whether they experience any limitations on their choice of footwear.
People with significant foot pain are encouraged to fill out a FHSQ prior to their initial consultation or prior to a specific treatment (ie-surgery) so their progress can be followed.
Click To Download
New Patient Registration Form - ACT Podiatry
If you are having surgery you will be required to fill out a Barton Hospital Consent Form and an ACT Podiatry or Podiatric Surgeons Consent Form. We have also attached a Barton Private Hospital Information Sheet (including location map and directions) for you assistance.
Barton Hospital Consent Form (see attachment)
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New Patient Registration Form - ACT Podiatry
ACT Podiatry/Podiatric Surgeons Consent Form (see attachment)
Click To Download
New Patient Registration Form - ACT Podiatry
Barton Private Hospital Information Sheet (including map and directions)(see attachment)
Click To Download
New Patient Registration Form - ACT Podiatry
Foot Health Questionnaire
INSTRUCTIONS
- This questionnaire asks for your views about your foot health.
- All you need to do is circle your answer to each question.
- If you are unsure about how to answer a question, please give the best answer you can.
The following questions are about the foot pain you have had during the past week.
foot and ankle conditions
- Hallux Valgus (Bunions – progressive dislocation of the big toe joint)
- Hallux Rigidus (Osteoarthritis of the big toe joint)
- Hammer/Claw Toes
- Plantar Forefoot Pain
- Heel Pain (including plantar fasciitis/plantar fasciopathy)
- Bumps and Lumps (bony and soft tissue)
- Arthritis (forefoot, midfoot, rearfoot and ankle)
- Complex foot and ankle complaints (patients with multiple concerns)
- Ingrown Toenail Surgery
- Something Unusual
faq
- What are Podiatrists & Podiatric Surgeons?
- What is the point of difference between
ACT Podiatry and other practices? - What are common forefoot conditions
treated at ACT Podiatry? - What are common mid-foot and rear foot
conditions seen at ACT Podiatry? - What predisposes a person
to lower limb pain - What are foot orthoses?
- Can a spinal condition cause foot pain?
- Is arterial disease a cause of foot pain?
- I am diabetic and my feet burn
– what is this? - Can in-growing toe nails and plantar warts be cured?
Suite 8 (Ground Floor), 146 Scollay St, Greenway ACT 2900
6287 4889
6293 2325
[email protected]
ACT Podiatry : Advanced Foot & Ankle Centre
Canberra Podiatric Surgeon
Suites 16-17 (First floor) 14-16 Brierly St, Weston ACT 2611
6287 2818
6293 2325
[email protected]
ACT Podiatry : Advanced Foot & Ankle Centre
Canberra Podiatric Surgeon
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