Richard K. Rettig, DPM - Appointment Request

*Items in bold are required.

Name: Email: Phone:

Are you a current patient?

Yes

Which office location(s) would you prefer for your appointment?

Philadelphia 1335 W. Tabor Road
Jenkintown 261 Old York Road

Preferred day(s) of the week for an appointment?

Any DayMondayTuesdayWednesdayThursdayFriday

Preferred time(s) for an appointment?

Any TimeMorningAfternoon

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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