Niagara Mobile Foot Care is now booking appointments for foot care with limited availability. All foot care appointments are triaged based of urgency. If you do not wish to fill out the form, please call (905) 708-9817 Online Intake Form Niagara Mobile Foot Care's online intake form to help make an appointment easier for you. Following your completion of the form reception will contact you to set up the date and time of your appointment via email. The form is confidential and only shared within the foot care team. Please enable JavaScript in your browser to complete this form.Please select oneNew Client Residential Home (WAITLIST)Previous Client Residential HomeNew Client LTC, Retirement Home, Group HomePrevious Client LTC, Retirement Home, Group HomeNew residential clients will be waitlisted at this time. Previous residential clients will be triaged based on their foot care needs. If you selected LTC, Retirement Home, Group Home, Please Specify We have contracts with some of the facilities throughout NiagaraContact NameFirstLastContact Email Contact Phone NumberIs the foot care for someone else?Yes No If yes selected please provide, the client's information below Name of ClientFirstLastPhone Number of ClientAddress of ClientAdditional CommentsI am aware of the Cancellation/ No Show Policy (during COVID-19 we are waving this cancellation cost- please always call and cancel your appointment if you are feeling unwell) YesAppointments that are not cancelled 24 hrs prior to your scheduled appointment will be subject to a cancellation fee of $20.00 (this includes same day cancellations and no shows). This fee will be added to your next appointment. Does the client have any urgent concerns? Appointments will be triaged based of urgent concerns. The client is in need of routine nail care, not an urgent concernThe client is experiencing the verbal expression of pain or detriment, without infection present (if infection present refer to family Dr.)Due to COVID-19 we have limited capacity per day for client appointments. Additional CommentsAdditional Comments Please select all that apply and region of Niagara that the client is located. St.Catharines - Residential House- Cost $45/visit/client for foot care May 2020- Rates have increased St.Catharines -Please add on finger nail care $5/ client with foot care cost during visit Facility/LTC/Retirement/Group Home (Please contact me with rate)Other - We can connect you with other nurses in the community In other regions of Niagara, you can be connected with an independent foot care nurse that will self schedule your appointment (Rates Vary). Examples-Thorold, Niagara on the lake, Welland, Port Colborne/Welland Port, St. Davids, Niagara Falls, Stevensville/Ridgeway, Vineland, Grimsby, WainfleetIf you selected LTC, Retirement Home, Group Home, Please Specify We have contracts with some of the facilities throughout NiagaraIf you live in St.Catharines, please select all the apply Please call me to complete the consent form and COVID -19 Screen over the phone with a representativePlease email me the consent form and COVID-19 screen formCopy RequestedAll forms must be completed on every client. You can request a copy for your recordsEmailSubmit
