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Patient Registration Forms

In order to serve you quickly and efficiently, please follow the instructions below and fill out the forms to the best of your ability:

  1. Please request an appointment with Allentown Family Foot Care.
  2. Choose to either fill out our A) Electronic Form Document* or B) downloadable PDFs for Team AFFC.
  3. Print and bring your completed forms to your scheduled appointment.

*After your submission of our Electronic Form document, you will receive an email confirmation asking for verification of your identity. Please follow the instructions in that email to complete the process.

If you are having trouble printing your documents, please call Team AFFC at 610-434-7000.

For information regarding insurance and payment methods, please visit our Insurance Information page.

Electronic Form

e-Form Document Submission

Downloadable PDFs

Podiatric History / Medical History Form

Personal Information / Demographics Form

Appointment / Cancellation Policy Form

Communication Consent Form (HIPAA)

Credit Card Agreement

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