Dr Foots State Registered Chiropodist
Application Form

 

 

Please complete the form below accurately as these are the details that will be present on the web site.

 

 

Your Name:

 

Address:

 

Telephone Number:

 

Mobile Number

 

Fax Number


Senior Chiropodist

 

Visiting Fee

 

Clinical Fee

Visiting Service hours

 

Clinical Service hours

 

Treatments Available
 
Yes
No
Removal of Corns & Hard Skin
Treatment of difficult to Cut Nails
Treatments of Verrucaes
Treatments of Athletes Foot
Ingrowing Toe Nail
Biomeachnical Evaluations
Orthotics
Sports Injuries
Heel Pain Treatment
Reflexology
Acupuncture
Home Visits

 

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Application Form