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Physician/RN/Healthcare Certification Form

Looking to show that your medical practice takes the health of your patients seriously? Become ACMFCE certified today!

Fill out the form below to start your application

ACMFCE PHYSICIAN/RN/HEALTHCARE Form
I have a current operational FDA approved autoclave sterilizer for all my instruments that I use to service my patient/client base for routine foot care or I use disposable instruments to deliver all medical foot care or esthetic services.
Maximum upload size: 1.54MB
I do not sterilize or disinfect my instruments with QACs liquid disinfectants immersions or sprays but use them for precleaning instruments or surface only.
I ultrasound or manually clean, brush, package and seal all my instruments prior to sterilization.
I protect and store my sealed packaged instruments appropriately and safely prior to each patient/client use.
I only use full strength undiluted high-level disinfection products for surface disinfection to include undiluted 70%-90% alcohol, accelerated hydrogen peroxide, or chlorinated products.(this does not include Bleach)
I will comply with all standards for 3 zone protection room air ventilation or Clean Air , N-95 masks and dust capture attachments for electric filing systems to protect my patients or clients from harmful airborne pathogens, nail dust or volatile organic compounds (VOC). If not already certified with a 3 zone protection or Clean Air Building certification, I agree to participate in a webinar to learn what it takes to be ventilation compliant, help avoid COVID-19 issues. I understand not attending the webinar risks losing my certification status.
I clean all patient’s or client’s exam chair, room chairs, head rests and contact areas between each patients or clients visit.
I use disposable gloves, disposables towels, disposable instruments, or protective barriers prior to all skin to skin contact, potential blood contact or bodily fluid contact services.
I promise to stay within my scope for practice, avoid aggressive services or improper use of all chemicals, products or instruments as a licensed professional and refer any and all patients or clients that could become harmed in any manner to an appropriate licensed professional who can appropriately treat or attend to the respective needs of the patient or client.
I permit an ACMFCE compliance phone call or physical visit each year to confirm my adherence to ACMFCE standards of foot care excellence.

My signature below affirms that I agree with the above ACMFCE standards and realize I may be removed from the membership without refunds of my membership fees if I violate any of the covenants or standards listed. In addition, by joining this organization As an ACMFCE certified member or as a full member I will politically advocate and allow my name to be used to support higher standards for foot care excellence at a local, state and federal level. My certification also allows my name only to be listed for the public to be notified by an online list that ACMFCE certified individuals or facilities are providing exceptional services that may exceed many state and federal standards and patients and clients should feel safer in their care.
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