To request an appointment call us at 902-835-7463 or complete the form below. Name* First Last Email* Phone*Have you ever been in to see us in the past?*YesNoPlease indicate all of the services you are interested in.* Custom Made Orthotics Footwear Modifications (ie: Leg Length Difference) Diabetic Foot Care Nail Care Lower extremity Injury Warts In-Grown Toe Nails Corn Callus Removal General - Lower Extremity Pain Compression Stockings Bracing Other Other reason for booking appointment.Please note: An appointment is not required for Footwear fittings.Date Requested* Do you have a referral/prescription? (Not required for all appointment types)*Yes (Please enter the referral information below or attach a copy of the referral)No (I do not have a written referral)What information is written on referral/prescription?If possible, please attach a copy of your prescription/referral. If you have multiple referrals please attached them all. Drop files here or Accepted file types: jpg, gif, png, pdf. EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.