peoria • pekin • east peoria

New Patient Form

Are you a new patient to Ruskusky Foot And Ankle Clinic? You can prepare for your first appointment by downloading and printing our New Patient form. Just fill it in during your spare time and then remember to bring the completed form with you to your appointment. To download the printable New Patient form, just click on the blue button below.

Get Acrobat ReaderNote: You will need Adobe Acrobat Reader to view and print the form. If you don't have Acrobat Reader installed on your computer, simply click on the yellow Adobe icon and follow the instructions for a free downloadable version, then return to this page to download the form.

Download New Patient Form