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(909) 3373449(877) 8889868PREFABRICATED/ SEMICUSTOM ORTHOTICS AND THERAPY AIDS ORDER FORM Please mail, fax or email completed Payment Information, Release and Order Form to: P.O. Box 3220 Blue Jay,

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How to fill out prefabricated semi-custom orthotics and

01

Remove the existing insoles from your shoes.

02

Place the prefabricated semi-custom orthotics in your shoes with the heel cup against the back of the shoe.

03

Ensure that the orthotics fit comfortably and provide the necessary support for your feet.

04

Wear the shoes with the orthotics regularly to allow your feet to adjust to the new support.

Who needs prefabricated semi-custom orthotics and?

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Athletes looking for additional support during physical activities.

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Individuals with foot conditions such as plantar fasciitis or flat feet.

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Individuals who spend long hours on their feet and need extra cushioning and support.

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What is prefabricated semi-custom orthotics?

Prefabricated semi-custom orthotics are pre-manufactured foot supports that provide a balance between custom and over-the-counter orthotics, allowing for some degree of personalization to fit individual foot shapes and conditions.

Who is required to file prefabricated semi-custom orthotics?

Healthcare professionals, such as podiatrists or orthopedists, who provide prefabricated semi-custom orthotics to patients may be required to file claims for reimbursement with insurance companies.

How to fill out prefabricated semi-custom orthotics?

To fill out prefabricated semi-custom orthotics, complete the necessary forms by providing patient information, diagnosis codes, fees, and details about the orthotics provided, ensuring all fields are accurately filled to support the claim.

What is the purpose of prefabricated semi-custom orthotics?

The purpose of prefabricated semi-custom orthotics is to alleviate foot pain, improve alignment, and enhance overall foot function, making them accessible for various foot-related issues.

What information must be reported on prefabricated semi-custom orthotics?

Essential information that must be reported includes the type of orthotic provided, diagnosis codes, patient demographics, provider information, and any relevant medical notes to justify the use of the orthotics.

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