Appointment Request
 


Foot & Ankle Institute
Dr. Jason Dickerson
 (801) 265-0600

 Salt Lake Office
5872 S. 900 E. Suite 150
Salt Lake City, Utah 84121

 Draper Office
11800 S. State Street Suite 350
Draper, Utah 84020
 (Lone Peak Medical Campus)

All Major Insurances Accepted

Fellow, American College of Foot & Ankle Surgeons
  To request an appointment time, please complete this form below. One of our staff members will
contact you to confirm your appointment availability and answer any questions you have. Or you may also call (801) 265-0600 Mon-Fri 8am-5pm to schedule an appointment.
Is there a specific date you
  		would prefer to come in?

Or
 
What day of the week would like you to come in?
What time of day do you prefer?
Name
Phone
E-mail
Please describe the reason for your appointment:

   

 

  

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