Are YOU Ready for Comfy Feet?

Appointment Request & Pre-Assessment Questionnaire
Let's get started on the road to comfy feet! Please fill out this form and we'll get an appointment set up for you. Only the contact information is required on this form. If you prefer, you may tell us the rest in person.

Contact Information

    Patient Name

    Patient History


    YesNo

    Please tell us how you heard about Comfort Shoe Specialists.

    Appointment Preference

    Hours of Operation:
    Closed Sunday and Monday
    Tuesday-Saturday 9:00 am - 5:30 pm
    Last appointment is at 4:30 pm

    Health Savings Accounts, Flexible Spending Accounts and Insurance

    A current prescription is required to have on file if you plan on using these benefits.


    TuesdayWednesdayThursdayFridaySaturdayCheck all days that would work for your appointment

    MorningMid-dayAfternoonCheck all times that would work for you

    Any additional notes regarding your preferred appointment time?