Before You Arrive

New Patient Information Form

Reason For Visit
Have you had a foot examination before?
Foot Related Conditions
Select any areas in which you have medical problems that have been diagnosed
Please list any medications (prescribed or over the counter)
Do you have allergies?

Office Policy and Privacy Policy

OUR PLEDGE TO YOU: The Chiropodist and staff at this clinic will make every effort to give you the best quality care in a professional and timely fashion.

TIME IS PRECIOUS: We will do our best to see you at your scheduled appointment time. Therefore, we expect that all patients be on time for their scheduled appointments. If you are late you may have to be rescheduled for another date and time.

APPOINTMENTS ARE PRECIOUS: Our office staff sends email and text reminders, however, it is your responsibility to keep track of your appointments and arrive at our office for the scheduled date and time. Patient’s calling to cancel an appointment must give 24 hours notice or the full fee for the appointment is charged.

PRIVACY POLICY: Due to the privacy act, our office requires your permission to discuss your condition or treatment information with any of the parties listed below.

I consent to the staff of the North Bay Foot & Ankle Clinic releasing information about my treatment at the clinic to the following parties:

Reason For Visit
Please note that our services are not covered by O.H.I.P. and we have a fee for service. You will be contacted by phone by one of our staff to schedule an appointment date.


Is my visit covered by O.H.I.P?

No, unfortunately our services are not covered by O.H.I.P.

Do I need an appointment?

Yes, visits to our office are by appointment only.

Is there wheelchair or handicap access?

Our current location is ground level, and provides wheelchair access to front and back of the building.

Where is parking located?

Our building offers free parking.

What is your cancellation policy?

We require 24 hours notice for appointment cancellation.

What do I need to bring to my appointment?

When you come to our office for your appointment, please bring footwear with you, as we would like to see the types and style of the shoes you wear the most. Ladies, please remove any toenail polish you may be wearing before arriving.

How do I make a payment?

Our office accepts cash, Visa, MasterCard and debit cards. We do not accept cheques. Payment is due the day of your visit, and you will be issued a receipt that you can use for income tax purposes or send in to your health insurance provider.

Do I need a referral?

Medical referrals are not necessary for you to book an appointment. However, some private health care plans will not reimburse your visit fee unless you have been referred by your family physician.

Is my visit covered by my private or work health insurance plan?

Possibly. Most insurance companies do have coverage for visits to a Chiropodist, as well as for orthotics and sometimes footwear. We suggest a patient contact their insurance provider to confirm their coverage, as well as inquire if they require a doctor’s referral before their visits will be reimbursed. You will pay us for your visit, and receive a receipt that you can send into your insurance company.

If you have coverage through Green Shield insurance, or the Veterans Affairs Canada, we can bill them direct. For Green Shield patients, please bring your insurance card with you to your appointment. For VAC members, we will need your card to confirm coverage.

Payment Instruction

Credit / VISA Debit:

  1. You can pay online with a credit or VISA DEBIT card in our online store.
  2. Follow this link:  
  3. From the drop down select Payment on Account and enter the amount you wish to pay
  4. Click Make Purchas, your shopping cart will open. Select Check Out
  5. If you are registered with us via email and you have not used our new online system, select forgot password. You will receive an email to reset your password. Follow the prompts to create a new password with your email address.
  6. Log / Sign In
  7. Enter your payment information and select place order.
  8. If you are not registered with us with an email address you can create an account or call us, and we can help you at 705-476-9172

You can also call us to pay with your Credit / Visa Debit Card (705) 476/9172


  1. Log into your online or mobile banking app and select Interac e-Transfer.
  2. Select the account you wish to transfer from.
  3. Under Recipient select Add New and enter our email address: [email protected]
  4. Use this guide below to determine the cost of your appointment.
  5. Enter the Amount in the Amount Field

In Clinic:

You can also come into the clinic during regular business hours to pay for your appointment at least 2 business days BEFORE your appointment via cash, debit, or credit.


Appointment Type




Stephanie Initial Visit


Stephanie Standard Visit


Stephanie Diabetic Standard Visit


Lucie Initial Visit


Lucie Standard Visit


Genesis Fungal Nail Treatment


G-Pulse Magnetic Stimulation


Nitro – Wart Treatment




Fungal Culture




Custom Orthotic


Custom Children’s Orthotic


Custom Orthotic Sandal




Partial Nail Avulsion – 1 Side – 1 Toe


Partial Nail Avulsion – 2 Sides – 1 Toe or 2 Toes 1 Side each


Partial Nail Avulsion – 2 Sides – 2 Toes


Total Nail Avulsion – 1 Toe


Total Nail Avulsion – 2 Toes