By submitting this form, I acknowledge and understand that Compassionate Soles provides non-invasive, preventive foot care services and does not diagnose, treat, prescribe for, or cure any medical condition.
I understand that services provided by Compassionate Soles are intended to support foot health, comfort, hygiene, and wellness and are not a substitute for medical care provided by a physician, podiatrist, or other licensed healthcare provider.
I certify that the information I provide is accurate and complete to the best of my knowledge. I understand that failure to disclose relevant medical information may affect the safety and appropriateness of services.
I understand that photographs submitted through this form will be used solely to assist in evaluating whether the requested service falls within the scope of practice of Compassionate Soles and to help determine the safest service approach.
I acknowledge that submission of this form and photographs does not guarantee that services will be provided. Compassionate Soles reserves the right to decline services or require medical clearance when conditions appear outside its scope of practice or when services cannot be performed safely.
I understand that if signs of infection, open wounds, ulcerations, severe inflammation, vascular compromise, or other conditions requiring medical evaluation are observed, I may be referred to a podiatrist or other healthcare professional.
I voluntarily consent to the review of my information and photographs and understand that my information will be handled confidentially and used only for purposes related to scheduling, assessment, service planning, communication, and care coordination.
I authorize Compassionate Soles to contact me by phone, text message, and/or email regarding appointments, intake information, scheduling, and service-related communications.
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