Haycock Foot and Ankle Center
  • Home
  • About Us
  • Services
  • New Patients
  • Contact

New Patients

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

​To download the forms, click on the "Download File" button below each 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
new_patient_biographical_intake_form.pdf
File Size: 662 kb
File Type: pdf
Download File

Privacy & Financial Policies
​

Picture
Privacy and Financial Policies
File Size: 2014 kb
File Type: pdf
Download File

acknowledgement_form.pdf
File Size: 391 kb
File Type: pdf
Download File

Medical
Background
​Information​

Picture
medical_history_intake_form.pdf
File Size: 1180 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