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Contactdrhaytmanek2024-01-15T16:15:44-07:00

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

Responses to inquiries submitted through the below form can take several days.

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Submit Case Review

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:*

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 2-6 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.*

Yes, I agree

No, I do not agree

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".

Which specialist would you like to provide your case review?*

Dr. Backus

Dr. Haytmanek

Name*

(First, Last)

Phone*

Email*

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

Gender*

Male

Female

Date of Birth*

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*

If chronic, please use 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.

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Sports Foot & Ankle Practice: Vail

Mailing Address
181 Meadow Dr, Suite 400
Vail, CO 81657

Driving Directions

180 S Frontage Rd W
Vail, Colorado 81657

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

Sports Foot & Ankle Practice: Frisco

226 Lusher Ct.
Suites 101 & 103
Frisco, Colorado 80443

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

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*

Contact our Team

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