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Booking Consultation Form

Please take a moment to complete our 3-part booking consultation form below as fully and accurately as you can.

It is an important part of the booking process, as it helps us understand your foot health concerns, review any relevant medical or treatment information, and assess photos where needed before your appointment. This allows us to recommend the most suitable service, provide a more accurate guide on pricing, and make sure enough time is allowed for your treatment.

Section 1:

Are you the Patient? *

What is your name and relationship to the patient?

Full Name of Patient *

Postal Code *

For where the patient would be seen at

Phone *

Patient Age range *

Where will the visit take place? *

How Urgent is you next visit? *

Preferred visit frequency *

Section 2:

Which feet need treatment? *

What issues are present? *

Thickened or overgrown toenails

Hard skin / callus

Corns

Cracked heels

Ingrowing toenail

Suspected fungal nail

Veruca

Nail damage or trauma

Not sure – needs assessment

Upload images of the feet (if available)

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 10 Files )

Describe the problems in your own words

Section 3:

Has the patient been diagnosed with diabetes?

Any known circulation problems? *

Is the patient on any Blood Thinner medication? *

Is the patient currently under GP or podiatry care? *

Please provide details of the GP or podiatry care

Patient mobility *

Access notes (optional)

Anything for us to be aware of? eg. parking, steps, lifts, care staff support

I have read and accept the Terms and Conditions at

https://ardsleyfootcare.co.uk/terms

I am happy for Ardsley Foot Care to contact me by text message or phone about my enquiry.

I understand that any initial opinion or price is only an estimate based on the information and photos I provide, and is not a diagnosis.

I consent to my submitted details and photos being reviewed for assessment and pricing.

I understand that final pricing may change once I am seen in person.

Would you like us to contact you to discuss the quote? *

Area: West Ardsley, Yorkshire

Call: 07361 591 007

Email: [email protected]

Site: ardsleyfootcare.co.uk

Click here to go to our Booking Consultation Form

Booking Consultation Form

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