330-899-9160

Patient Forms

Click below to download PDF versions of our patient forms. Please print, fill out and bring in to your appointment.

 New Patient Intake Form

•  Red Flag Rule

•  Race & Ethnicity Letter

 Patient Update Form

 

New Patient Checklist:

1.   Arrive 15 minutes prior to your appointment to allow time to complete your chart.
2. Bring a Photo Id that includes your name & Picture. Your Picture will also be taken in the office for your chart.
3. Bring your current Insurance Card(s)*.
4. Bring a Current Medication List.
5. Be prepared to pay any co-pays, if applicable.

* If your insurance requires a referral, it is your responsibility to have that in place.

** If you are unable to keep your appointment, please call the office at 330-899-9160 to cancel or reschedule at least 24 hours in advance.



Dr. W. Joseph Schoeppner, D.P.M.
Green Foot & Ankle Care
3333 Massillon Road, Suite 203
Akron, OH 44312

Phone: 330-899-9160
Fax: 330-899-9170

©2012 Green Foot & Ankle Care. All rights reserved.