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919.962.6637

Selene G. Parekh, MD
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Foot and Ankle Service

Appointment Forms

If you are a NEW patient to Dr. Parekh, please complete the following three forms before your first visit.

[1] Health Assessment Form;

[2] Visual Analogue Form;

[3] Where is your pain? Please choose the appropriate form below or from the picture:

Pain in your big toe.
Pain in your toes, other than the big toe.
Pain in your ankle or heel.
Pain in the middle of your foot.

UNC Orthopaedics | CB #7055, Bioinformatics Building | UNC School of Medicine | Chapel Hill, NC 27599-7055