1455 Bench Rd, Suite B • Pocatello, ID 83201 • (208) 232-0006 • Email Us

Patient Registration Forms



We welcome you to Valley Foot and Ankle. If you wish to make an appointment, please call the contact number to the right and speak to our receptionist. Then, link to each of the forms below, print it, fill it out, and return it to us by email, fax (208-233-8771), or US mail in advance of your appointment. This will expedite your clinical registration, reduce your waiting time, and allow us to focus more directly on your problem. Thank you for your patronage. We recognize that you have many options for foot care, and we appreciate your choosing us. We believe you have chosen wisely.

 

New Patient Information

Health History

Financial Agreement

Privacy Practices

 



Family feet
Name:
Email:
Phone:
Preferred Contact:



Valley Foot & Ankle
1455 Bench Rd, Suite B
Pocatello, ID 83201

208-232-0006

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© 2016 Valley Foot & Ankle