Southern Illinois Foot & Ankle Clinic

New Patients

Southern Illinois Foot & Ankle Clinic is accepting new patients. Please call our office regarding your insurance questions.

New Patient Information Forms:
Click on the links below to access the New Patient Forms. After you click the link, a browser window will open. After it opens, click on the 'PRINT' icon on your Browser. After the forms print, fill them out and bring them to your first appointment. Completing the New Patient Information Forms will save you time on your first visit to our office.

Key Forms

New Patient Registration Form*
Notice of Privacy Practices

*You must have an Acrobat Reader to view the Acrobat files. If you don't already have Adobe Acrobat, you can download the Acrobat Reader Free.

Scheduling and Cancellations:
Please call our office or use our Appointment Request Form. Appointments are scheduled based on circumstances. Please call our office at least 24 hours prior to your appointment if you are unable to keep the appointment. Any appointment that is not cancelled 24 hours prior to the scheduled appointment time will be charged a $25.00 fee. This fee will be billed to the patient directly and he/she will be responsible for payment.

Bring to Your Appointment:
  • Insurance card
  • List of all current medications and allergies
  • Any online forms you filled out prior to your appointment

When to Arrive:
Please arrive 15 minutes before your scheduled appointment time to allow time for registration.

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