New Kent Foot Clinic · Srikanth Mahavadi, DPM(804) 557-3317
New Kent Foot ClinicContact / appointments ↗

BEFORE YOUR FIRST VISIT

Tell us about
your foot health.

Share your demographics, insurance information, a brief foot or ankle complaint, diagnosed medical conditions, current medications, and previous surgeries.

Not sure of an answer? That’s okay.

If you can’t remember or don’t know an answer, leave it blank or enter “unknown” where possible. Dr. Mahavadi and the care team can review these details with you during your appointment. Bring your insurance card and a medication list if available.

Your answers are used to generate a PDF in your browser. This page does not save your answers or send them automatically. Download your PDF before leaving or refreshing the page, and bring it to your visit.

If the clinic has instructed you to email your form, use “Email / share PDF” below to choose an email app on supported devices. You can also download and attach the PDF manually.

This form is not monitored for emergencies and does not book an appointment. For a medical emergency, call 911 or go to the nearest emergency department.

REVIEW & FINISH

Your completed intake.

Check your answers, then share the PDF with your email app or download a copy. The PDF is prepared in your browser and is not sent until you send it from your email app.

Email recipient: newkentfootclinic@gmail.com
Subject: New patient registration — [your last name]
On supported devices, “Email / share PDF” passes your PDF to your chosen email app. Verify the recipient and subject before sending; your app may not fill them automatically. If sharing is unavailable, download the PDF and attach it using “Open email draft.”