Intake Form for Foot Care AppointmentPlease enable JavaScript in your browser to complete this form.Contact 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 Policy Yes Please select the area of Niagara that the Client is located. (availability updated daily).St.Catharines (Feb 13-14th) Cost $35/clientThorold (Feb 24th) Cost $40/clientNiagara on the Lake (Feb 25th) Cost $40/clientOther - We can connect you with other nurses in the community Other regions of Niagara, we can connected with an independent foot care nurse that will self schedule your appointment. Examples- Welland, Port Colborne/Welland Port, St. Davids, Niagara Falls, Stevensville/Ridgeway, Vineland, Grimsby, WainfleetEmailSubmit
