Rockford, IL Foot Care Center
Mary C. White, DPM

    

New Patients

Welcome New Patients!

We always welcome new patients and try to offer convenient appointment times.

Please contact our office to schedule an appointment or use our Appointment Request form.

All new patients are asked to complete the new patient registration forms, and must present their insurance card(s)upon their first visit with our office. It is also the patient's responsibility to bring their referral, if required, with them to our office.

We ask that all new patients arrive a minimum of 15 minutes prior to their scheduled appointment in order to complete the registration process. Patients who have already completed the registration forms (by accessing them through our web site or by picking them up at our office) need only arrive 10 minutes prior to their scheduled appointment time.

Click on the links below to access the New Patient Form. After you click the link, a browser window will open. After it opens, click on the 'PRINT' icon on your Browser. After the pages print, fill them out and bring them into our office.

Access the Patient Portal

Key Forms

Download
New Patient Registration Form*
Notice of Privacy Practices
Section 1557 - Affordable Care Act (ACA)

*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.

Request an Appointment

   

 
 
    
Schedule Appointment