Partner Program

Patient Order Form

  • The final section allows you or the patient to place a secure order online.

  • Receipts will be immediately emailed to you and the patient once the order is submitted.

  • Within 1 business day they will receive two more emails with tracking information for the foot mold impression kit.

Partner Program

Patient Order Form

  • The final section allows you or the patient to place a secure order online.

  • Receipts will be immediately emailed to you and the patient once the order is submitted.

  • Within 1 business day they will receive two more emails with tracking information for the foot mold impression kit.

View Sample Patient Order Form