Name
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Phone
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Email
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Primary Insurance Company
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Referring Physician
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Preferred Location
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Preferred Location *
Cortez, CO
Durango, CO - Primary Office
Durango, CO - Podiatry Office
Pagosa Springs, CO
Idaho Falls, ID
Meridian, ID
Farmington, NM - Primary Office
Farmington, NM - Podiatry Office
Gallup, NM - Primary Office
Gallup, NM - Podiatry Office
Blanding, UT
Holladay, UT
Layton, UT
Monticello, UT
St. George, UT
Preferred Location
Health Condition
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Health Condition *
Men's Health - Benign Prostatic Hyperplasia
Men's Health - Varicocele
Pain Management - Frozen Shoulder
Pain Management - Osteoarthritis
Pain Management - Spinal Fractures
Podiatry - Achilles Tendon Injuries
Podiatry - Ankle Injuries
Podiatry - Bunion Treatment
Podiatry - Corns & Calluses
Podiatry - Diabetic Foot Care
Podiatry - Flat Feet
Podiatry - Foot & Ankle Surgery
Podiatry - Foot Pain
Podiatry - Gout
Podiatry - Heel Pain
Podiatry - Ingrown Toenails
Podiatry - Laser Treatments
Podiatry - Nerve Pain
Podiatry - Neuropathy
Podiatry - Orthotics
Podiatry - Plantar Fasciitis
Podiatry - Podiatric Surgery
Podiatry - Sports Injuries
Podiatry - Tendonitis
Podiatry - Toe Nail Fungus
Primary Care - Anxiety
Primary Care - Birth Control
Primary Care - Chronic Disease Management
Primary Care - Depression
Primary Care - Dermatology
Primary Care - Diabetes
Primary Care - Lab Testing
Primary Care - Laser Treatment
Primary Care - Pediatrics
Primary Care - Physical Exams
Primary Care - Preventative Healthcare
Primary Care - Preventative Medicine
Vascular - Peripheral Artery Disease
Vascular - Vein Insufficiency
Vascular - May-Thurner Syndrome
Women's Health - Uterine Fibroids
Women's Health - Pelvic Congestion Syndrome
Wound Care
Other
How soon would you like to be seen?
*
How soon would you like to be seen?
As soon as possible
Within the next 7-10 days
Within the next 30 days
Please share any additional information that can assist our team in scheduling your appointment.
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