Re-Order Your New Orthotics!

It has been one year since your last custom orthotic order. Many insurance plans allow for updated orthotics yearly. If there have been no changes to your insurance, you are likely eligible for an update.

The “Foot Levelers Orthotic Review” form below is required for us to process your order. This form allows our office to better document necessity for your updated products.

Once you have submitted the form, you will be provided with a link to Foot Levelers products. Call our office to provide us with your choice of orthotic. Our staff is also available to answer any questions.

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    Rate your overall improvement in pain since daily use of custom orthotics began.

    Using a scale from 0 to 10, please rate only those that apply below.
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