Wednesday 22nd Jan, 2020
Wednesday 22nd January, 2020
ADVANCED Foot & Ankle Centre
6287 4889 Tuggeranong
6287 2818 Weston Creek

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)

New Patients Form – ACT Podiatry (Relevant to all patients)(see attachment)

Click To Download

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.

Foot Health Status Questionnaire Form (FHSQ) (see attachment)

Click To Download

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.

Surgical Patients Only

Click To Download

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)

Click To Download

ACT Podiatry/Podiatric Surgeons Consent Form (see attachment)

Click To Download

Barton Private Hospital Information Sheet (including map and directions)(see attachment)

Click To Download

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.

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