Foot Management Inc 7201 Friendship Rd Pittsville, MD Foot-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Account Number and Account Name at the top of the form. This information is essential for processing your order.
3. Fill in the Shipping Address, including City, State, and Zip Code. Ensure accuracy to avoid delivery issues.
4. Provide Patient Information such as Name, Age, Weight, and Occupation/Activity. This helps tailor the orthotic solutions to individual needs.
5. Complete the Prescriber’s details including Name and Phone number. This is crucial for any follow-up regarding prescriptions.
6. Select the Type of Shoe and Orthotic from the provided options. Circle your choices clearly to ensure correct processing.
7. Specify any additional requests or services needed in the Additional Requests section at the bottom of the form.

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