ACOT Services - Footcare Registration Form

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in North West Devon

  Registered Charity No: 1011780

Working from Moor to Shore

 

Please use this form to register for our nail cutting service which will be run in the Okehampton hospital.

Please note this service provides nail cutting only and is not suitable for people who have:  

  • diabetes
  • surgery to arteries in legs or feet
  • intermittent claudication / severe poor circulation
  • corns, callus, severely thickened or deformed toe nails
  • severe foot / toe deformities
  • recurrent foot infection requiring antibiotic therapy

If you have any of the above complaints please do not fill in this form. You may wish to discuss your foot problem with your GP or refer yourself to your local NHS podiatry clinic for an assessment.  

(This form can be completed by anyone on behalf of the applicant) 

 

Applicants details
e.g. Alex Mary Smith
Enter date as dd/mm/yyyy
Address
e.g. Honeysuckle Cottage

e.g. 12 Ackroyd Street


Contact details (no spaces)
Medical contact details
e.g. Dr. John James

e.g. East Street, Okehampton

Name of person completing form


Date format dd/mm/yyyy

This is for authentification purposes. Thank you

e.g. Heath Service job

Please note: 

  • The voluntary toe nail cutting service provides a toe nail cutting service for people who have healthy feet and healthy toe nails.
  • This is not an NHS podiatry treatment and is why Age Concern is proving this service.
  • Tthis service is only available to those who are unable to manage their own personal foot care. 

Treatment will be provided by an Age Concern volunteer who has been trained by an NHS podiatrist.

The volunteer is not a podiatrist and is not qualified to assess feet or foot problems. 

Agreement of applicant.

There is an administrative charge of £5.50 for toe nail cutting and £1.50 for finger nail cutting.

I have completed this form accurately and understand that if I do not have healthy feet and healthy toe nails I cannot be treated by an Age Concern volunteer.

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