Pedicure Information Form
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Are you diabetic?
Do you have any allergies?
If so, what are you allergic to?
With respect to your feet and legs, which of these conditions do you experience and how often?
Tired Sensation in Legs
Heavy Sensation in Legs
Do you currently see a podiatrist? If so, what doctor?
What are some concerns you have with your feet? (pain/discomfort)
What improvements would you like to see in your feet?
Should be Empty: