Unit 389 – Provide a Nail Cutting and Care Service
Treatment Evidence Form
College Name:
College Number:
Learner Name:
Learner Number:
Date:
Client Name:
Address:
Profession:
Tel. No: Day
Eve
PERSONAL DETAILS
Age group: Under 20 20–30
Lifestyle: Active Sedentary
Last visit to the doctor:
GP Address:
30–40
40–50
50–60
60+
CONTRAINDICATIONS REQUIRING MEDICAL PERMISSION – in circumstances where medical
permission cannot be obtained clients must give their informed consent in writing prior to treatment
(select if/where appropriate):
Haemophilia
Any condition already being treated by a GP,
dermatologist, nurse, podiatrist or another
practitioner
Medical oedema
Arthritis
Infected/ingrowing toenail
Nervous/Psychotic conditions
Recent operations of the hands/feet
Diabetes
Inflamed nerve
Undiagnosed pain
Acute rheumatism
Neuropathy (loss of feeling in the feet)
CONTRAINDICATIONS THAT RESTRICT TREATMENT (select if/where appropriate):
Infectious or contagious diseases
Under the influence of recreational drugs or
alcohol
Any known allergies
Undiagnosed lumps and bumps
Inflammation
Cuts
Severe bruising
Abrasions
Scar tissue (2 years for major operation and 6
months for a small scar)
Recent fractures (minimum 3 months)
Poor circulation
Broken bones
Sensitivity to products
Severely bitten or damaged nails
Nail separation
Eczema
Psoriasis
Dermatitis
Loss of skin sensation
Chilblains
Corns
Verrucae
Wart(s)
Clients taking Warfarin
Involuted (curved) toenails
Thick toenails which are causing the client
discomfort
DISEASES AND DISORDERS (select if/where appropriate):
Beau’s line
Discoloured nails
Koilonychia
Onychatrophia
Onychogryphosis
Onychophyma
Paronychia
(Whitlow)
Eczema
Blue nail
Eczema
Lamella dystrophy
Onychauxis
Onycholisis
Onychoptosis
Pitting
Sepsis
Psoriasis
Bruised nail(s)
Flaking
Leuconychia
Onychia
Onychomycosis
(Tinea Unguium)
Brittle nails
Transverse ridges
Dermatitis
Unit 389 Provide a Nail Cutting and Care Service - Treatment Evidence Form V1
Dry nails
Hang nail(s)
Fungal Infections
Onychocryptosis
Onychophagy
Onychorrhexis
Pterygium
Vertical ridges
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NAIL TEST:
Moisture content
Cuticle condition
Skin condition
Skin’s healing ability
Circulation
Excellent
Excellent
Dehydrated
Excellent
Good
Good
Good
Dry
Good
Normal
Fair
Fair
Normal
Fair
Poor
Poor
Poor
Poor
Overall Skin/Nail Condition:
Unhealthy foot
Healthy foot
Treatment (select if/where appropriate):
Nail Cutting for the hands
Nail Cutting for the feet
Massage of the hands
Massage of the feet
Nail finishes:
Coloured varnish
Clear varnish
Patient with Diabetes
Yes
No
GP approval required
Yes
No
Date letter sent to GP for approval…../…../…..
Date response received from GP…../…../…..
Client Accepted for Nail Care
Yes
No
Have you ever had a foot ulcer? Yes
No
Do you bleed excessively when you cut yourself? Yes
Have you previously had foot care treatments? Yes
Do you have mobility problems?
Yes
No
No
No
The information above is correct
I am happy for you to make contact with my GP
GP’s Address:…………………………………………………………………………………………………………………
GP’s Post Code:…………………………………………. GP’s Telephone Number:……………………………………
Treatment details:
Treatment Given
Client’s Left Foot
5
4
3
2
Client’s Right Foot
1
1
2
3
4
Massage
5
Yes
Varnish
No
Yes
No
Comments/Observations ……………………………………………………………………………………………………
………………………………………………………………………………………………………………………………….
Client feedback:
Unit 389 Provide a Nail Cutting and Care Service - Treatment Evidence Form V1
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Home care advice:
I understand that this service is provided by …………………………………………..(Nail Carer) who is trained to cut
nails. I understand that the service offered is not a Podiatry or Chiropody service but a basic foot care service
Client’s Signature…………………………………………………
Learner’s Signature……………………………………………….
Date ………………………………………………………………….
Unit 389 Provide a Nail Cutting and Care Service - Treatment Evidence Form V1
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