Or call 07960 045 745 to make an appointment.
Please print out and fill in this Health Questionnaire ready for your Podiatrist.
This questionnaire is for your safety and our information. The information is strictly confidential.
DATE OF BIRTH (DD/MM/YY)
NAME OF GP
HEALTH INSURANCE COMPANY (IF APPROPRIATE)
POLICY NO GROUP NO/AUTHORISATION
HOW DID YOU HEAR OF US?
Have you had any of the following? If yes, please tick
Long Term steroids
Anti Coagulant Therapy
What drugs are you presently taking?
As your comfort and safety is our priority please do not hesitate to tell us if you feel uncomfortable during the treatment or have any questions.
I understand that I am responsible for the cost of my treatment. Should I fail to attend a treatment without giving 24 hours prior notice then I am liable for a cancellation fee.
I consent to treatment by the Podiatrist in attendance.
Occasionally, I would like to email you information about their latest offers and new services.