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Contactdrhaytmanek2019-07-01T13:29:05-06:00

For urgent or acute cases, please call us at 970-476-1100

Response to these inquiries can take several days

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Submit Case Review

Our team welcomes your Film Review for a fee of $500. To initiate a second opinion, please complete the below form. Once the form is completed, you will be directed to instructions on how to move forward.
Please note: due to high volume, film reviews may take up to 4-6 weeks.

I understand that the Clinical Case Review that I will receive is preliminary and limited because it does not have information typically obtained through a physical examination. The absence of a physical examination could affect the ability to diagnose my condition or injury. This Clinical Case Review is not intended to replace a full medical evaluation or an in-person visit with a physician. I agree to solely assume the risks of the limitations associated with this review and understand that no warranty or guarantee is made to me concerning a specific result or cure of my condition or injury. I have read and agree to be bound by these conditions.*

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In order to complete a case review with our team, you must agree to our terms. If you would like to ask our team a question, please click here and select the option "Ask a Question".

Name*

(First, Last)

Email*

Phone*

City / State / Country*

How did you find us?*

Physician Referral

Family/Friend Referral

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N/A

Other

Referring Physician Name

Referring Family/Friend Name

Gender*

Male

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Date of Birth*

(MM/DD/YYYY)

With this case review, what can we help you with?*

Discuss surgical options

Discuss alternative treatments

Second opinion

Other

Insurance Provider*

If uninsured, please note that you are uninsured.

Injury Side*

Right

Left

Both

Did your injury occur to your foot and/or ankle?*

Foot

Ankle

Both

Date of Injury*

(MM/DD/YYYY) If chronic, please put date when pain began.

Brief Description of Injury*

Description of Symptoms*

Have you received a diagnosis from another physician?*

Yes

No

If so, please describe the physicians diagnosis

Prior Medical History*

Prior Surgical History*

If no surgical history, please state none.

Current Medications*

If you are not on any medications, please state none.

Case Review Information*

I will download the Review & Payment form and will mail it to the office.

You will receive a Review & Payment document when this form is submitted.

Name*

(First, Last)

Email*

Phone*

City / State / Country*

How did you find us?*

Physician Referral

Family/Friend Referral

Internet Search

N/A

Other

Referring Physician Name

Referring Family/Friend Name

Medical Issue*

Your Question:*

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The Practice of Dr. Thomas Haytmanek

181 West Meadow Drive,
Suite 400
Vail, Colorado 81657

Phone: (970) 476-1100
Fax: (970) 479-5835

Sports Foot & Ankle Practice

181 West Meadow Drive,
Suite 400
Vail, Colorado 81657

Phone: (970) 476-1100
Fax: (970) 479-5835

Reviews

"Sports Foot & Ankle is by far the one of the best groups of foot and ankle specialists. My ankle is as good as new!" - Steve P.
See All Reviews for Dr. Haytmanek

DISCLAIMER
All information contained on the sportsfootankle.com website is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. (Website Terms and Conditions, Privacy Policy, and Industry Relationships)
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*For urgent or acute cases, please call us at 970-476-1100*

Response to these inquiries can take several days

For urgent or acute cases, please call us at 970-476-1100