Name *

First Name

Last Name

Phone *

(###)

###

####

How would you prefer to be contacted for appointment availability? *

Email

Text

Phone Call

Are you currently experiencing any of the following? (Check all that apply) *

Thick or Discolored Toenails

Peeling Skin

Itchy Feet

Burning Sensation Between Toes

Dry Skin

Cracked Heels

Foot Odor

Sweaty Feet

Curved or Painful Toenails

Involuted Toenails

Ingrown Toenails

Corns or Callus

No Nail or Skin Issues

Other

Do you have any of the following medical conditions or symptoms? (Check all that apply) *

Neuropathy

Lymphedema

Currently on Anti-Cancer Drug Therapy

Diabetic

None

Other

How often do you get pedicures? *

Weekly

Biweekly

Monthly

Rarely

Never

Have you ever received a medical-grade pedicure service? *

Yes

No

What do you value most in a pedicure? (Select up to 3) *

Cleanliness and Strict Sanitation Protocols

A Relaxing and Comfortable Experience

Expertise in Addressing Nail or Skin Issues

Long-Lasting Results

Personalized Care and Attention

Use of High-Quality Products

Would you prefer a pedicure service that offers: *

A Quick, Efficient Grooming Session

A Detailed, Restorative Session Focused On Long-Term Foot Health

Have you heard of the Neaten Method for foot and nail care? *

Yes

No

Have you experienced any challenges with previous pedicure services? (Check all that apply) *

Lack of Cleanliness

Poor Results or Short-Lasting Effects

Lack of Attention To Specific Foot Health Needs

Other

Would you like to receive updates on our services, promotions, or new products?

Yes, via email

Yes, via text

No, thank you