Thank you for choosing Fremont Foot and Ankle for your podiatric care. In order to set up your patient profile, please complete this secure registration form. Once submitted, our team will send you an invitation via email to create your username and password to access your personal patient portal.

Through your portal, you'll be able to:

• View your appointment history
• Access your treatment plans
• Communicate with our team
• Review your medical records
• Request prescription refills

If you need assistance completing this form or have any questions, please contact our office at (719) 275-1037. Your privacy and security are important to us. All information provided is protected and handled in accordance with HIPAA regulations.