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Client Information Form

Please read and fill out and submit form.

The information is collected for the use of the staff of Diana’s Divine Escape and is never shared with 3rd parties unless it is a medical emergency.

We are only providing Mobile Nail Care.

Regular Pedicures, Manicures, Advanced Pedicures Toenail & Fingernail Cutting.

Foot Care Nurse and Hair Services are currently not available. We are hiring. 

These services are for Seniors and those who are ill or immobile, younger adults with compromised immune systems or those unable to leave home to get services done for medical reasons.

Taxes are included. 

Travel and parking fee may apply.

 

Diana does Advanced Pedicures and has been working with Seniors Feet for over 15 years. All Services are currently done by Diana. 

Thank you.

Please select all service(s) wanted below:

Please check travel fee box below.

Are you suffering from a medical condition, illness, or injury?

Thanks for submitting!

Diana will contact you soon to book the appointment

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