FootCareMD Patient Testimonial Form

Share Your Story!

Your positive story about your foot or ankle treatment can be a valuable resource for other patients. Tell us how your foot or ankle condition affected you and how your treatment made a difference in your quality of life. We’ll feature stories on www.FootCareMD.org, the patient website run by the American Orthopaedic Foot & Ankle Society, and on social media.

If you have questions, please email FootCareMD@aofas.org or contact the American Orthopaedic Foot & Ankle Society at 800-235-4855 or +1-847-698-4654 (outside US).

Thank you for sharing your story!

Patient's Name*

First NameLast Name

Parent/Legal Guardian Name (required only if patient is under age 21)

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Country

Phone Number

Please enter a valid phone number.

Email*

example@example.com

What was your foot or ankle problem and why did you seek treatment?*

How did your surgeon treat your problem?*

How has your treatment made a difference in your life?*

Who was the surgeon that helped you? Were any other staff involved in your care?*

Can we share your thanks with the surgeon/medical team that provided your care?*

YesNo

If you have any photos that illustrate your condition, surgery, or recovery, please upload them here.

Is there anything else you would like to tell us?

Can we contact you if we have questions?*

YesNo

Signature (if the patient is under age 21, a parent/legal guardian must sign on their behalf)*