foot prints
Home Office Locations Services Dr. Jon T Middelton Dr. Steven Richman Appointments Office Staff Forms Insurance & Payment Billing Patient Education Links Privacy Practices City Of Toccoa City Of Commerce City Of Cleveland City of Winder

 

 

 

 

Patient Forms

New Patient Consent Form

Page 1  Page 2  Page 3

Please download/print all the above forms and bring to your appointment 

 

 

 

 

Disabled Person's Parking Affidavit (form MV-9D) http://motor.etax.dor.ga.gov/forms/motor.asp

 

Other Forms

Record Release Form

X-Ray Release Form

 

 

All these forms require Adobe Acrobat Reader

 

The Family Foot Care Center

 679 Hospital Road  Commerce GA 30529 (706) 335-4884

2109 Hwy 129 S Cleveland GA 30528 (706) 865-0666

711 Rose Lane Toccoa GA 30577 (706) 886-9441

153 North Broad Street Winder GA 30680 (770) 867-1770

EMAIL:  familyfootcarega@yahoo.com