I, ____________________________ understand that I am being seen for podiatric issues.

The care is known to be effective only when provided on a regular basis. Lapses in my treatment, such as missed days or sporadic days, or failure to comply with the plan of care can result in this therapy becoming less effective, ineffective or made worse. I understand that, without my active participation, my doctor’s ability to help me is limited.

My responsibilities include but are not limited to:

1. Learning how to promote my own health and wellness. Being an active partner in my medical care/healing.
2. Learning how to manage illness, both acute and chronic.
3. Actively working to eliminate those unhealthy habits I have acquired over my lifetime.
4. Eating properly, exercising if indicated, and striving to eliminate those stressors within my control.
5. Understanding my diagnosis, learning about its effects on my body and how I can help manage it.
6. Understanding the medical advice I receive. Asking questions when I do not understand the advice offered.
7. Taking my medications as prescribed if prescribed.
8. Notifying On 2 Feet, LLC prior to stopping or changing dressing treatment or my medication.
9. Notifying On 2 Feet, LLC should I have any adverse reaction from my prescribed treatment.
10. Completing diagnostic tests (lab, x-ray, EKG, etc.) in a timely fashion.
11. Appearing for treatment as scheduled.
12. That I will not miss any more than one (1) day of treatment in the entire recommended treatment plan.
13. Notifying my doctor when I have added other professionals to my healthcare team.
14. Notifying On 2 Feet, LLC if other professionals have prescribed new medication.
15. Being honest about what I am doing, taking, and who I am getting treatment from.
16. Know the rules of my insurance policy.
17. Notifying the office if contact information changes.
18. Having an emergency contact listed.
19. I understand that violation may result in discharge.