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Call our office at (913) 364-1314 Opt. 1 to check availability for same day urgent appointments. The Walk-In clinic is currently closed until further notice.

New Patient Forms

During the first scheduled New Patient visit, we make sure to obtain important background information such as your pertinent medical history and give you time to get to know your doctor. We accept most insurances, but contact your carrier to ensure Dr. Ali Davis in an in-network provider.


Please arrive 15 minutes early to your scheduled appointment if you are unable to complete the initial paperwork. The following items are strongly recommended to ensure accurate and safe patient care:

- Insurance card(s)
- List of current prescriptions and/or over-the-counter medication, including dose and frequency
- Pertinent medical and surgical history (cancer, diabetes, rheumatology, cardiology, etc)
- Recent labs results, x-rays, or relevant records

Surgery Forms

pdf downloadBefore Foot Surgery

pdf downloadFollowing Foot Surgery

New Patient Forms

pdf downloadPatient Registration

pdf downloadPrivacy Policy

pdf downloadRelease of Information Form

pdf downloadConsent to Treat Minor Children

Self-Pay Information

pdf downloadCash Pay Price List

pdf downloadSelf-Pay Contract

Insurance and Payment Information

Commercial policyholders (Non-Medicare/Tricare beneficiaries) that have not met the deductible for the year:
New Patient: One-time $100 fee due at first visit (Scheduled or Walk-In Clinic)
Coinsurance Plans: $50 due at follow-up appointments
***For additional information regarding the difference between copay/coinsurance, please click here.

The Foot Clinic collects copayments and coinsurances upon arrival. You are responsible for copayments or charges that are not covered by your insurance. Overpayment at The Foot Clinic will result in a refund after claims have been processed by your insurance.

Specific questions regarding insurance coverage and benefits should be directed to your employer or insurance company. For billing and processing information, please contact our Billing Department at 1-913-364-1314, ext #3.

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