I give permission for Specialty Foot Care by Richard Lee, RN or his qualified designee to provide nail care for the above listed patient.
I understand that services will be provided every month/every other month.
The cost of each service is $35 per visit. Please choose your billing option:
1 - Upfront in advance ($35 x 3 = $105)2 - Secure credit card on file
Billing preference/please fill out all information:
1 - I would prefer to receive emails2 - I would prefer to receive paper mail