New Patient

Patient Registration for Podiatrist in Midlothian, VA

At Earnest Foot & Ankle, our staff looks forward to establishing a relationship with you. On your first visit, we'll be requesting important health history information, medications you may be currently taking and anything else that will allow us to establish a foundation with you.

Patient Pre-Registration

Please complete the three links below, print out each, and have the forms completed upon arrival. Your completion of these registration forms will allow for a smoother flow to your scheduled appointment.

Please note: If you are unable to print and complete our forms prior to your visit, we ask that you arrive at our office 15 minutes prior to your appointment time.

HIPAA

Contact Waiver

Health History Form

HIPAA Compliance Notice

What to Expect?

Being prepared for your appointment will allow our doctors to obtain all the information needed to provide the best quality of care possible for you. We want you to feel comfortable, relaxed, and worry-free.

Give us a call today at 804-594-1944 for any questions. We look forward to your first visit.