Dashboard E Medical Assessment Medical Assessment ConsentInformationAssessmentPhotosNotes0% Complete1 of 5 Consent Form Select Client * Adameee TillierreBethe TillereJay MacleodShirley Austin Assessment Date I understand that by signing this agreement, I authorize The Foot Care Nurse to perform upon me the following Foot Care procedures as necessary: Nail Clipping and Filing Dremelling E-filing Corn and Callus Care Ingrown Nail Care Client Confirmation I have been informed of the purpose for the above general care and specific procedures, including the possible complications. I release the Foot Care Nurse from any responsibility for adverse effects or consequences unless those effects/consequences result from negligence in the performance of care. I give permission to the Foot Care Nurse to obtain digital photos of my feet and my feet only before and after foot care visits for progress of foot care. These photos may be shared with healthcare professionals and the general public for educational purposes. Client name and personal information remain confidential at all times. My signature on this form certifies that I have read and understood the above consent and that the care and procedures noted above has been fully explained to me. Client Signature signature keyboard Clear Foot Care Nurse Confirmation I have fully explained the purpose of the treatment as well as the risk, consequences and possible complications to the client within my professional scope of practice . Foot Care Nurse Signature signature keyboard Clear If you are human, leave this field blank. Next Start Over