Private Pay to Patients

Permission is hereby granted to Certified Foot Care Nurse Sara Ste-Croix RN BScN to facilitate the provision of foot care services and procedures as may be deemed necessary. I understand that this will include foot care examinations and services, including toenail, corn, and callus care, patient education, and appropriate referrals for other indicated treatments.

Failure to maintain health through proper nail and skin care can reduce mobility, cause foot discomfort, and lead to skin and nail disorders. As with any treatment requiring the use of sharp instruments, there is a small risk of injury and infection to surrounding tissue. Extreme care and caution will be used at all times.

Payment Details:
– $70 Initial visit
– $60 Follow-up treatment
– $10 Fingernail clipping (add-on)

Payment is to be made in cash or via e-transfer to sara@lakeviewfootcare.ca after service completion.
Late payments will incur a $10 fee every 30 days if not received within 30 days of the appointment.

By signing below, I certify that I have read this informed consent, and I hereby request and give consent for foot care services to be
provided by Sara Ste-Croix RN, BScN.