Sweet Feet Diabetic Foot Wellness Bar

Client Info

First Name

Last Name

Phone *

Email *

Date of birth *

Emergency Contact: *

Emerg. Phone *

Basic Wellness Info
Sweet Feet provides non-clinical wellness only.

Do you have diabetes? *

Yes

No

Foot concerns (check) *

Dry skin

Thick nails

Calluses

Swelling

Other

Seeing a podiatrist/physician? *

Yes

No

Any recent open wounds, infections, sores? *

Yes

No

Service Interests

Foot Baths: *

Classic (15m)

ACV (15m)

Foot Care: *

Nail Trim

Callus Smooth

Wellness: *

Grounding (30m)

BP Check

Glucose Check

Microscope (Add-On)

Bundles: *

Bath+Trim (30m)

Bath+Callus (30m)

Full Combo (30m)

I understand services cannot be done if I have open sores, wounds, infections, bleeding, swelling, or need podiatry clearance.

I understand Sweet Feet provides preventive wellness only. No diagnosis/treatment. I agree to report any changes or concerns.

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