Member American College of Foot and Ankle Surgeons
Member APMA American Podiatric Medical Association

CONFIDENTIALITY NOTICE: 

Littleton Foot and Ankle Clinic has implemented security measures to protect the privacy of your information. However, there are no systems that are 100% secure or error free.

Please do not include any HIPAA sensitive information in the reason for referral.     
In adherence to HIPAA privacy laws, we acknowledge that this form may contain information that is privileged, confidential or otherwise protected from use and disclosure.  We will ensure that any outside review, disclosure, copying, or dissemination of this transmission, or taking of any action in reliance on its contents, or other use is strictly prohibited.

Referral Request

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Referring Provider

Thank you for your referral, of your patients, to the Podiatrists of Littleton Foot and Ankle Clinic. At Littleton Foot and Ankle Clinic, our focus on the patient and providing the best possible care means your patient is in good hands.   

Please complete the referral form and our staff will contact your referral within 24 hours.  

If you don't wish to use this form, please contact our office at (303) 933-5048 to talk to our staff or email info@littletonfootandankleclinic.com

Thank you for choosing Littleton Foot and Ankle Clinic where we will take good care of your patient.

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