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Apis custom shoe order form

Apis custom shoe order form 2025

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The document is a Custom Orthotic/Shoe Modification Order Form from APIS Footwear, designed for ordering custom orthotics and shoe modifications. It includes sections for patient information, shoe specifications, diagnosis options, and customization details for orthotics and shoe modifications. The form allows for specific requests regarding materials, sizes, and modifications to address various foot conditions.

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Click ‘Get Form’ to open the apis custom shoe order form in the editor.
Begin by filling in the P.O. No., Bill To, and shipping details including Address, City, State, and Zip. Ensure all contact information is accurate for seamless communication.
In the Patient Name section, provide the patient's name along with their sex, weight, and height. This information is crucial for customizing the shoes.
Indicate whether you are ordering with shoes by selecting 'Yes' or 'No'. If yes, specify the Shoe Style and Color from the catalog provided.
For the Custom Orthotic Order Section, mark any diagnoses that apply and indicate problem areas on the foot using O for ulcers and X for calluses/pain points.
Fill in specifications for orthotics including material choices and base density. Be sure to specify quantities as needed.
Complete the Shoe Modification Order Section by detailing any modifications required such as rocker types or flares. Provide measurements where necessary.

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2008	4.9 Satisfied (38 Votes)

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