North Fork Podiatry
 
 
Southold Podiatrist

Use the convenience of our web site to request an appointment and save yourself a few extra "steps"! Our Office will contact you by phone upon receiving your completed form.


Tell us about yourself:

* Required Information


Title / Salutation


First Name*


Last Name*


Daytime Phone Number*


Cell Phone Number*


Email Address*

Have you been seen by Dr. Buffone before?

Yes

No

Preferred office location:

*


Preferred day of week (Select top two preferred days):

Monday   Tuesday   Wednesday   Thursday   Friday  Saturday 

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

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