New Portal Login Request


Please submit the requested information. You will receive an email from our office with a password to use when logging into our patient portal within one business day. Please notify the Gahanna office at 614-939-9330 or the Newark office at 740-344-8286 if you have any trouble.

* Required Fields

First *MiddleLast *
Address *
City *
State *
Zip *
Phone 1 *  Ext  Type 
Email Address *
Confirm Email Address *
Sex *
Please enter characters in the picture below
Anti-Spam Code *
Change the CAPTCHA codeSpeak the CAPTCHA code
  ( Click Once )
Foot and Ankle Specialists of Central Ohio - Offices in Gahanna, Newark, Pataskala and Sunbury