I give permission for Specialty Foot Care by Brooke Gordon, RN or her qualified designee to provide nail care for the above listed patient.

I would like services every other month.

I would like services monthly.

Please choose your billing option:
1 - Credit Card on file to be billed AFTER each completed visit (secured)2 - Cash, Check, or Credit Card paid at time of service3 - Invoice emailed AFTER each completed visit

Please choose your billing/receipt option (emailed preferred):
1 - Emailed invoice/receipt2 - Mailed invoice/receipt

Billing questions should be directed to Specialty Foot Care, LLC @ 303-980-0015 or main@specialtyfootcare.com