NEW PATIENT FORM

Welcome to WCBL! We are so happy that you have chosen us to be your provider for your orthotics and prosthetic needs. Below you will find our new patient form, please complete this prior to your appointment. By selecting which office you prefer to visit, the form will be sent to that office and we will do our best to accomodate your preference. When coming to your first appointment, please bring your insurance card, photo identification, prescription (if you have it) and the prescribing physician’s contact information. Please fill out the form below. You may also download and print the form, click here.