Columbus: (614) 866-2477
Gahanna: (614) 939-9330
Lancaster: (740) 653-2656
Newark: (740) 344-8286
North Gahanna: (614) 478-2111
East Columbus: (614) 235-2323
Westerville: (614) 939-9330
Dublin: (614) 339-2000
Pickerington: (614) 545-4321
Lancaster: (740) 653-2656

We appreciate the opportunity to provide your foot care needs. To help “de-stress” your visit and to help us maintain social distancing in our office, please complete the attached registration paperwork prior to your visit. This will allow you adequate time to accurately provide the complete information. Answer all questions to the best of your ability. If you are not able to fill out this form on your own, ask a relative or friend to help you provide the requested information.

pdf podiatry patient form downloadNew Patients

Bring these items with you to your appointment:
- Completed patient registration forms
- Insurance card(s)
- Photo ID
- List of any medications you are currently taking
- Referral authorization (if applicable)
- Co-pay/deductible if applicable

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