Request an Appointment!

Use the convenience of our web site to request an appointment and save yourself a few extra "steps"!

Request an appointment online by completing the form below, or you may call us at our office at: 816-455-8900.

Our office will contact you upon receiving your completed form. (Note: if you have not received a call back within 24 hours from you request (Monday - Thursday), please follow up with the office at 816-455-8900 to make sure that the request was received.

Tell us about yourself:

* Required Information

Title / Salutation

First Name*

Last Name*

Date of Birth*

Insurance Company*

Daytime Phone Number*

Email Address*




Zip Code*

Please indicate how you would like to be contacted:



Have you been seen by Fine Foot Care Center before?



Preferred Day of Week (Select top two preferred days):

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*Please list the nature of your problem, question or comment: