Patient Forms

Click below to download PDF versions of our patient forms. Please print, fill out and bring in to your appointment.

New Patient Checklist:

  1. Arrive 20 minutes prior to your appointment to allow time to complete your chart
  2. Bring a Photo ID that includes your name & picture. Your picture will also be taken in the office for your chart.
  3. Bring a utility bill if your address is different than what appears on your driver's license. Refer to the above Red Flag Rule.
  4. Bring your current insurance card(s)*
  5. Bring a current medication list
  6. Bring Power of Attorney Forms if needed
  7. Be Prepared to pay any co-pays if applicable

* If your insurance requires a referral, it is your responsibility to have that in place.

** If you are unable to keep your appointment, please call the office at 330-899-9160 to cancel or reschedule at least 24 hours in advance.

Please note, there will be a charge for any missed appointments

W. Joseph Schoeppner, D.P.M
Green Foot & Ankle Care, LLC
3333 Massillon Road Suite 203

Akron, OH 44312

Phone: 330-899-9160
Fax: 330-899-9170

©2016 Green Foot & Ankle Care. All rights reserved.