Nail Surgery Scotland

Please give us some information about your problematic toenail/s. This helps us during your online assessment call.

A photograph is also really helpful - it is easier to complete this form from your mobile phone.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a phone number we can contact you on to discuss your assessment further

How long has your toenail been problematic?

One month3 months6 monthsOver a year

What caused the problem with your toenail/s?

Have you had any previous treatment for your problem toenail/s?

PodiatristGPDermatologistNo - I haven't had any previous treatment

Have you been prescribed any antibiotics for your toenail problem?

Yes, one courseYes, more than one courseNo

On a scale of 0-10, how painful is your toenail problem?

Does your toenail problem affect your work or sports activities?

YesNo

Please take a photograph of your problem toenail/s for us to assess

Once we have reviewed your information, we will contact you to discuss the details further. When is the best day/time to call?

I consent to my information above being reviewed by a podiatrist and to be contacted to discuss further options for treatment. Signature