Forms & Payment
Accepts new patients
| Medicare | Medicaid | Workers' compensation | Other |
|---|---|---|---|
Medical insurance plans and payment options
Please call the office at 919.962.6637 to see if we are enrolled as a provider with your insurance company.
Thank you.
Please call the office at 919.962.6637 to review payment options.
Thank you.
Office information from Selene G Parekh, MD
AOFAS (Big Toe) Hallux Metatarsophalangeal Interphalangeal ScaleHaving pain in your big toe. Please be sure to complete this form prior to your first visit.
AOFAS (Other Toes) Lesser Metatarsophalangeal Interphalangeal Scale
Having pain in your toes, other than the big toe. Please be sure to complete this form prior to your first visit.
AOFAS Ankle-Hindfoot Scale
Having pain in your ankle or heel. Please be sure to complete this form prior to your first visit.
AOFAS Midfoot Scale
Having pain in the middle of your foot. Please be sure to complete this form prior to your first visit.
New Patient: Health Assessment Form
Coming to the office for your first visit. Please be sure to complete this form prior to your visit.
New Patient: Visual Analogue Form
Coming to the office for your first visit. Please be sure to complete this form prior to your visit.
Contact Information
Other staff in my practice
3609 Southwest Durham Drive
Durham, North Carolina 27707
919.471.9622
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