Yale Podiatry Group Summer Foot Screening Clinic
Please use this form to register for the next pediatric foot screening clinic. This free clinic is for children ages 1-17.

364 East Main Street
Ansonia, CT 06401

Email address *
Phone Number *
Parent's Name *
Child's Name *
Child's Date of Birth *
Describe your child's current foot and/or ankle issue:
When did the problem start?
Child's Shoe Size
A copy of your responses will be emailed to the address you provided.
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