Request an Appointment

Online Appointment Requests:

Same Day Appointments

A same day appointment may be available to evaluate your foot condition if scheduled by 2:00 pm.

Please complete the form below. Fields in RED are required.

Contact Information

First Name

Middle Name

Last Name

Goes By

Home Phone

Cell Phone

Work Phone

Contact Preference

Address

Street Address

City

State

Zip Code

Personal Information

Date of Birth

Gender

If you are diabetic please mark this box.

Insurance Carrier and Type of Insurance

What type of pains / problems are your experiencing?

Primary Care Physician

Name

Phone

Date of Last Visit

Street Address

City

State

Zip Code

Pharmacy

Name

Phone

Street Address

City

State

Zip Code

Appointment Details

Desired Appointment Location

Are there any dates or times that do not fit your schedule?

Message

Office Hours

Greensboro
Monday - Friday: 8:30 am - 5:00 pm

Winston-Salem
Monday - Friday: 8:30 am - 5:00 pm

INSURANCE & BILLING

Foot Centers of NC will gladly accept and file all medical insurance for which we participate. We currently are a contracted network provider with most insurance plans. It is important that patients are aware of the benefits offered by their own particular insurance plan. The patient is responsible for obtaining a referral, if required, from their primary care physician prior to their appointment. We understand that insurance matters can be confusing. If you need assistance, an insurance specialist is available Monday - Friday 8:00 am to 5:00 pm by calling 336.765.8643.