Patient forms

Patients Forms

Please print and fill out the appropriate patient form and bring it completed to your next appointment:

UFAC Registration Form
UFAC Medical History Form
UFAC PAD Test Form


University Foot & Ankle Centers accepts most private insurance plans and Medicare.

We gladly accept all major credit cards, HSA cards, cash and check.

University Foot and Ankle accepts the following insurance plans

• Aetna (HMO needs a referral from
• Amerigroup
• Americhoice
• Beech Street
• Blue Cross/Blue Shield
• Cigna (HMO needs a referral from the DR’s Office)
• First Health/Coventry
• Great West (part of cigna)
• HealthSpring/HealthSpring (IPA Needs referral from PCP)
• Medicare
• Multiplan
• Prime Health Services
• Signature Health Alliance
• Tricare South (prime needs a referral, standard does not need a referral)
• United Healthcare
• Humana
• Amerivantage (Medicare replacement)
• Secure Plus Primary (Medicare replacement plan through Americhoice)
• Mail Handlers (Coventry is the network)
• TN Care Select
• Med Advantage Multi Plan
• Colonial Life Ins.
• Humana Medicare
• Humana Medicare HMO(some plans require a referral from the pcp)

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