Naturally Bare Client Questionnaire


Naturally Bare
4764 Fishburg Road
Suite D3
Huber Hts, Ohio 45424
Where Feet Find Comfort and Wellness!
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Email *
Appointment Date: *
MM
/
DD
/
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First Name: *
Last Name: *
What is your 10 digit phone number with area code? *
What type of phone number did you list today? *
What is your birthday month and day?  (example December 29) *
How did you hear about us? *
Did another customer refer you today? *
If yes, who referred you today?
Is this your first time experiencing waterless pedicure? *
How committed are you to using recommended products to help improve your overall feet? *
What type of shoes do you wear often?
(Select all that apply)
 *
Required
How often do you get professional pedicures? 
(Select all that apply)
*
Required
Are you diabetic? *
Are you pregnant? *

Do you engage in any physical activities or sports regularly?

 *

Are you currently taking any medications that could affect your feet or overall health?

 *

Do you have any medical conditions relevant to foot health?

 *
Do you have a podiatrist? 
 *
If yes, who is your podiatrist?

What products do you currently use on your feet and how often?

 *

Any specific foot concerns or areas you want to address during the pedicure? 

 *
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