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Chicago Pediatric Orthotics
  • Home
  • Map
  • Cranial Remolding
  • Lower Extremity
  • Spinal Bracing
  • Before your visit
    • Home
    • Map
    • Cranial Remolding
    • Lower Extremity
    • Spinal Bracing
    • Before your visit

Chicago Pediatric Orthotics

EN

  • Home
  • Map
  • Cranial Remolding
  • Lower Extremity
  • Spinal Bracing
  • Before your visit
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Form, forms, forms

  • Signed physician's prescription
  • Insurance card
  • Intake forms from bottom of this page.  
  • Identification 
  • Bring shorts if you or your child are being evaluated for lower limb braces or inserts for ambulation.
  • For spinal evaluation, we need to be able to see as much of the spine as possible.  For girls snug shorts and a bra or bathing suit top.  For boys, bike shorts, or boxer briefs.
  • Bring most recently worn brace or insole so we can discuss your orthotics & Prosthetics preference and improvements we can make.

We are conveniently located in Skokie with easy access for families from Chicago, Evanston and the North Suburbs.  

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Insurance

We are currently contracted with the following insurance providers:    

  Aetna 

BCBS PPO

Blue Choice 

County Care

MedRisk

Meridian

Multiplan

and others please call to confirm


We are trying to get contracted with ALL insurance companies.  Please ask your insurance provider to add Chicago Pediatric Orthotics to their provider list.  

Forms to Complete and Bring to Your Child's Appointment

Please choose ONE and fill out the intake forms and bring them to your first visit.   Thank you!

Late Policy-Please read (docx)

Download

Intake forms - infant head shape (pdf)

Download

Intake forms - infant toddler (pdf)

Download

Intake forms Scoliosis (pdf)

Download

Intake forms - Child Youth age 4 and up (pdf)

Download

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Follow on Instagram "kidsbracing'  

 

We have a signed parental photo release for all images displayed on our web page.