Helper text: Use your own clinic reference, patient initials + birth year, or any code from your practice system. This is used only to identify the orthotic on delivery.
This helps generate actionable data we can feed back to you and your clinic / business
(optional — printed on your orthotic)
Select "Mirror both feet" if both orthotics are identical. Select "Design both feet separately" if each foot requires different design specifications.  

You've selected independent left and right specifications. Before continuing, please open and complete the bilateral prescription form here: https://book.rehabhub3d.com/widget/survey/VKpXGpct3DqhOKq72WF6. Use the same patient reference. Once submitted, return here and click Continue

2mm standard.
Degrees
Degrees
mm
Degrees
Degrees
3mm thickness as standard unless requested otherwise
Ceramic and synthetic leather only available in low and standard heel cup depths

Patient & Clinic Reported Outcomes

Please take 60 seconds to answer the below questions. This will allow us to return outcome measure data specific to your clinic back to you as well as improving our service.

Select any resources to send automatically to your patient after this order is submitted (if patient email has been entered)
Patient's subjective complaint 

RehabHub3D - Exercise Rehabilitation

RehabHub3D pairs structured exercise rehabilitation with your orthotic prescription. Clinics using both report improved patient outcomes and higher satisfaction scores.

Rehab Aids & Payment

Add condition-specific rehab aid bundles to your order. For full bundle descriptions visit www.mmpodiatry.com. Payment is taken securely via Stripe on submission or via invoice.

Please include patient name if not previously included