Appointment Form - New England Podiatry

Appointment Request

PLEASE NOTE: If you have any questions or concerns please do not use forms. Instead, please call our office:
Chestnut Hill: 617-232-1752
Newton: 617-630-8280

If this is a medical emergency please contact emergency services by calling 911.

ESTABLISHED OR RETURN PATIENTS that have been seen by us within the last 3 years have the option to book their own appointment using Mass General’s Patient Gateway portal if they have a Gateway account: patientgateway.org

NEW PATIENTS or patients that have not seen us in the last 3 years please use the form below. Our scheduling coordinator will contact you by phone to arrange your appointment by the next business day (Mon-Fri). Please do not submit any Protected Health Information (PHI).

First Name (required)

Last Name (required)

Phone (required)

Email (required)

Location

Appointment date

Notes to the Doctor

Terms
I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.

SMS Opt-in (Optional)
I agree to receive text messages about appointments, service updates, and patient care at the phone number provided. Consent is not a condition of service. Message and data rates may apply and message frequency may vary. Reply STOP to unsubscribe or HELP for help. See our Privacy Policy and Terms of Service.