Request Appointment Request Your Appointment First Name Last Name Email Address Phone Number Insurance Name Insurance ID Number Date of Birth Best Time To Contact You Best Time To Contact You Morning 10 AM to 12 PM Afternoon 12 PM to 2 PM Late Afternoon 2 PM to 4 PM Early Evening 4 PM to 6 PM Which Treatment You Are Seeking? Which Treatment You Are Seeking?Power Heel Program For Plantar Fasciitis (Not covered by Insurance)Laser/Clear Nail Program For Fungal Nails (Not covered by Insurance)Swift Therapy/Clear Wart Program for Plantar Warts (Not covered by Insurance)SMART neuropathy program For Peripheral Neuropathy (Not covered by Insurance)Power Heel Program For Achilles Tendonitis (Not Covered by Insurance)Laser treatment For Foot arthritis (Not covered by insurance)Laser treatment For Unknown Foot Pain (Not covered by insurance)3D Printed Custom Orthotics (Not covered by insurance)Onyfix For Ingrown Toenails (Not covered by insurance)Hyprocure for Flat Feet (Not covered by Insurance)MIS Surgery for BunionMIS Surgery for HammertoeCustom Sandals/Crocs (Not covered by Insurance)Laser treatment For Foot Neuroma/Plantar Fibroma (Not Covered by Insurance) Question Agree to Consent Agree to Consent I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form. I agree for this website to store my details and use them to contact me via email and telephone and to receive text messages. Msg & data rates may apply.. The information you provide will be used solely for appointment information, booking, reminder, and related information for your care, promotional offer and marketing purpose and insurance verification. You agree with the storage and handling of your data by this website in accordance with our Privacy Policy listed at the bottom of the page. Request My Appointment