Rx For Nail CarePlease fill out the information for your patient. Rx can also be faxed to (520)900-5462 Name * First Name Last Name Email * Phone * (###) ### #### Rx: * Service Requested: Elder High Risk Pedicure Elder High Risk Pedicure w/ Fungal Nail Laser Treatment Custom Orthotics Shoe Measurement/Fitting Fungal Nail Laser Treatment Additional Information: Provider's Name First Name Last Name Thank you!
