New Patients - Request an Appointment
Use the convenience of our website to request an appointment and save yourself a few extra "steps"!
Our office will contact you upon receiving your completed form.
Tell us about yourself:
Mr. Mrs. Ms. Dr. Prof. Title / Salutation
First Name*
Last Name*
Primary Phone Number*
Cell Phone Number*
Email Address*
Date of Birth*
Insurance Company*
Web Search Referred by Friend Yellow Pages Direct Mail/Magazine Other
Please indicate how you would like to be contacted:
Phone
Email
Have you been seen by FEET for LIFE Podiatry Centers before?
Yes
No
Select Ofice No Preference University City/Clayton Office Fenton Office *
Preferred Day of Week (Select top two preferred days):
*Please list the nature of your problem, question or comment: