Metropolitan Podiatry Associates, PLLC Appointment Request
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Name *
First MI Last
Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
xxx-xxx-xxxx
Phone Type *
E-mail address
Requested Date and Time *
MM
/
DD
/
YYYY
Time
:
Which doctor would you like to see? *
Is this your first visit with us? *
What type of appointment would you prefer? *
A telemedicine consultation requires a smart phone, tablet, or computer with a video camera and microphone.
If this is an in-office appointment, which location would you prefer? *
What is the purpose of your appointment? *
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