Submit Online Prescription — Footmed Orthotics

Clinic

Relevant Hx/Findings

Arch Height

Orthotic Style

Comments

Shell Specifications

Shell Thickness

LDPE default is 2.8mm.

Rearfoot Posting

Please specify left and right. Will be corrected to perpendicular unless stated.

Topcover

Topcover Length

Comments

Please indicate thickness of heel raise if requested

Comments

Please comment on style/placement of metatarsal pad/neuroma dome or required thickness of any forefoot posting.

Special Instructions

Any further information you would like the lab to know, or if you wish us to contact you please indicate here.

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