Canton • 132 RiverStone Terrace,
Suite 101 - Map to this location
Cherokee County

Cumming • 236 Atlanta Road
Map to this location
Forsyth County

Jasper • 51 Gordon Road
Map to this location
Pickens County

Ellijay • 97 Hefner Street, Suite 202E
Map to this location
Gilmer County

Buford • 4700 Nelson Brogdon Blvd.E
Map to this location
Gwinnett County

Dahlonega • 134 Ansley Drive,
Suite 400 - Map to this location
Lumpkin County

Schedule an Appointment

Need to schedule an appointment? Please complete the New Patient Questionaire and bring it to your first visit. You can call our office at 770.889.9596 or fill out the form below. Requests are generally completed within 24 hours and every effort is made to make your appointment for the time/date you request. Should we not be able to fulfill your request, a North Georgia Foot & Ankle Clinic representative will contact you.

* Denotes required fields

Patient's Full Name & Address *

Patient's D.O.B

Day Phone *

Evening Phone

Email Address *

Which Office Would You Like to Visit *

Preferred Time Of Day *

Preferred Date Of Appointment *

Reason For Visit

Are You A Current Patient?	Yes No

Has Your Insurance Changed Since Your Last Visit?	Yes No

If you are a New Patient or an existing Patient with changes to your insurance; please provide the following information.

Insurance Company

Insurance Company Phone

Insurance ID Number

Insurance Group Number

Insurance Policy Holder (If different from patient)