DeSimone Foot & Ankle Centre
761 Lasalle Blvd. Sudbury, Ontario P3A 1X3
(705) 560-FEET (3338)
Hours of Operation
Save time on your first visit by completing the new patient form before your appointment.
Payment and Private Health Insurance: No part of the treatment cost is covered under O.H.I.P. You may however be covered under 3rd party insurance. I acknowledge that the staff are willing to assist me in recovering my insurance entitlements. I understand that insurance is a contract between me the insured and the insurance carrier, not between the insurance carrier and the Clinic and that I am responsible for payment.
Privacy Policy: You have the right to read the Notice of Privacy Practices which provides a description of office treatment, payment activities and healthcare operations, of the uses and disclosures we may make to your protected health information, and other important matter about your protected health information. We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
I have read the above conditions of treatment and agree to their content. I hereby give the above named Clinic permission to administer the necessary treatment in order to assess and treat my present foot condition, after it has been explained to me. All missed or cancelled appointments without 24 hour notice are subject to a visit charge.