New Patient Forms

Southern Illinois Podiatry welcomes new patients! We accept most insurance, but please call for verification. Take time to review our cancelation policy, new patient forms, and what to bring to your appointment. Please call our office for any further questions you may have before your visit. We look forward to working with you.

Scheduling: Please call our office at (618) 988-6034 or click on our Appointment Request button on the website.

New Patient Information Forms: Save time by completing these forms prior to your first visit!.

Download Key Forms

New Patient Form (1 MB)

Privacy Practices (129KB)

Telemedicine Consent Form (49KB)

*You must have an Acrobat

*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.

Please call our office at least 24 hours prior to your appointment if you are unable to make it. Rescheduling can be done at this time.

Bring to Your Appointment:
Insurance card
Any online forms you filled out prior to your appointment
List of all current medications and allergies
When to Arrive: Please arrive 15 minutes before your scheduled appointment time to allow time for registration.