Haycock Foot and Ankle Center
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New Patients

To minimize your wait time, please print and complete the forms below and bring them to your first visit.

The forms will provide us with your biographical information, medical background, and agreement with privacy and financial policies. 

​To download the forms, ​click on the "Download File" button below the image.

In addition, to help patients and staff who have asthma and allergies, please refrain from wearing perfumes, colognes, or scented lotions to your appointments.

​We look forward to seeing you!

Biographical
​Information

Picture
20230317_new_patient_form.pdf
File Size: 1759 kb
File Type: pdf
Download File

Privacy & Financial Policies
​

Picture
hfac_privacy_and_financial_policy_2022-01.pdf
File Size: 2265 kb
File Type: pdf
Download File

2311 Baton Rouge Ave.
Lima, OH 45805

419-228-FEET (3338)

Hours

​Mon-Thu: 7am-12pm, 1pm-4pm
Fri:             7am-1pm
​
  • Home
  • About Us
  • Services
  • New Patients
  • Contact