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 FormFollowing the 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 (Booking for the week of July 13th)Previous Client Residential Home (Booking for the week of July 13th) New Client LTC, Retirement Home, Group HomePrevious Client LTC, Retirement Home, Group Home If you selected LTC, Retirement Home, Group Home, Please Specify We have contracts with some of the facilities throughout Niagara Please select all that apply 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, WainfleetContact 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 ClientI 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 residential client appointments. Additional CommentsPlease select all the apply Please call me to complete the consent form/ COVID -19 Screen over the phone with a representativePlease email me the consent form/ COVID-19 screen formThis option is only available for St.Catharines clients or clients in LTC/retirement/group homes. All forms must be completed on every client.MessageSubmit
