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Get a Second Opinion

Please complete this form to request an appointment to get a second opinion on your diagnosis. We will contact you as soon as possible!

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Name*

Email*

Day Time Phone Number

Date of Birth*

Preferred Location

Avondale Office

Chandler Office

Gilbert / Mesa Office

Phoenix (West) Office

Phoenix Office

Sun City Office

Tucson Office

Reason for Request

Unfortunately, Pongratz is not able to treat diabetic shoe patients at this time.

Consent*

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