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Orthotic Ordering Form

Orthotic Ordering Form 2026

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The document is a prescription form for Foot Management, Inc., detailing the necessary information for custom orthotic shoe inserts. It includes sections for patient and prescriber details, shipping information, diagnosis, shoe type and size, orthotic specifications, and additional accommodations. The form also outlines popular orthotic options and instructions for foam impressioning to create accurate molds of the patient's feet.

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Click ‘Get Form’ to open the Orthotic Ordering Form in the editor.
Begin by entering the patient's name, age, weight, and sex in the designated fields. This information is crucial for tailoring the orthotic solution.
Fill in the prescriber’s details including their name and phone number. This ensures proper communication regarding the order.
Provide shipping information by completing the account number, P.O. number, and shipping address sections. Accurate details will facilitate timely delivery.
In the diagnosis/additional requests section, specify any particular needs or conditions that should be considered when creating the orthotics.
Select the type of shoe and orthotic required from the provided options. Ensure you choose based on patient activity levels and preferences.
Complete measurements for length and width of orthotics as well as any specific accommodations needed. This step is vital for comfort and effectiveness.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Are orthotics ever covered by insurance?

While these specialized inserts can significantly improve your quality of life, their price tag often causes sticker shock. The good news? Many insurance plans cover custom orthoticsyou just need to know how to navigate the process.

Will insurance pay for orthotics?

Some insurance companies do not pay for custom orthotics. Others will only cover them if you have specific medical conditions. Take time to do your research and review your insurance plans restrictions.

How much can I expect to pay for orthotics?

There are many types of custom orthotics, and they can cost anywhere from $300 to $800. Semi-custom orthotics cost between $60 and $300, and basic off-the-shelf inserts are available for as little as $10 to $20. Some health insurance plans wont pay for custom-made orthotics.

Does insurance cover good feet orthotics?

No. The Good Feet store is not a medical provider and does not accept payment through insurance. Both Tread Labs and The Good Feet Store do however offer reimbursement through FSA/HSA accounts.

Can orthotics be ordered online?

Custom orthotics can be ordered online from many websites, but the best online store to buy custom-made orthotics is Upstep, the foot-pain relief company.

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Do you need a prescription to get orthotics?

Custom-made orthotic devices may control pain if you have certain problems, such as an unusual-shaped foot, or if your foot rolls toward the arch (pronation). Custom-made orthotics are available by prescription. They can be costly, and provincial health plans or private health insurance may not pay for them.

How to get assessed for orthotics?

We recommend a biomechanical assessment for a podiatrist to assess your feet and recommend which orthotics will work for you. Can orthotics help fix flat feet? Orthotics will not change your foot structure. They will, however, support your flat foot when walking, running or standing for long periods of time.

Orthotic Ordering Form 2026

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