La Mesa Podiatrist | La Mesa New Patients & Forms | CA | JERRY M. FABRIKANT D.P.M. F.A.C.F.A.S |

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JERRY M. FABRIKANT   D.P.M. F.A.C.F.A.S

MEDICAL AND SURGICAL TREATMENT OF THE FOOT & ANKLE

(619) 465-3443


New Patients & Forms

We welcome all new patients with open arms and warm smile.  As a new patient we ask that you take the time to complete our new patient registration formPlease download and bring the completed form to your scheduled appointment.

Patient Registration Form:

Patient Registration Form PDF Version 
(Write in with a pen)
For Adobe Acrobat PDF viewer 
click here .

Scheduling and Cancellations:

Please call our office to schedule an appointment. If you are unable to make your appointment, please notify us 24 hours in advance. Failure to cancel your appointment prior to 24 hours notice may result in a cancellation fee of $25.

 

What to bring to your appointment:

  • Insurance card and Valid Identification
  • Names of your other doctors
  • List of all current allergies and medications
  • Any online forms you filled out prior to your appointment
  • Recent medical records or x-rays will be helpful


When to arrive:

 Please arrive 20 minutes before your scheduled appointment time to complete any forms. We strive to stay on schedule and do not double-book our patients.


Contact Us

Please do not submit any Protected Health Information (PHI).