Take your Foot Wellness Questionnaire

Take 5 minutes to answer some simple questions about your foot health, submit the questionnaire, and one of our foot care specialists will contact you via email or text to schedule a free online telemed consult with no obligation!

Click on the foot shape that best describes your foot.

Do you currently suffer from any of the following foot ailments (click all that apply)?

What activities do you participate in (click all that apply)?

What type of shoes do you often wear and are seeking support for (click all that apply)?

Please upload the below pictures so we can have a view of your foot shape, arch height, heels, ankles, footwear, and any current orthotics or arch supports. You can upload up to three (3) pictures of pairs of shoes and two (2) views of orthotics.

IMPORTANT: For privacy reasons, all pictures must be taken as shown in the samples and NO pictures of face or images that would compromise privacy should be submitted.

1. Standing Pictures

Please stand naturally on a flat surface. Follow the angles shown in the samples below (Front, Back, Inside, Outside).

Standing Front Standing Back Standing Inside Standing Outside

2. Seated Pictures

Sit comfortably with your feet on the floor. Follow the angles shown in the samples below (Flat, Heels Raised, and Crossed Legs showing the bottom of each foot).

Seated Flat Seated Raised Seated Crossed Left Seated Crossed Right

3. Footwear / Shoes

Please upload up to 3 pictures of the shoes you wear most often (Top view and Sole view). You can upload multiple files at once.

Shoes Top Shoes Sole

4. Current Orthotics or Arch Supports

Please upload up to 2 views of your current orthotics (Top view and Side view). You can upload multiple files at once.

Orthotic Top Orthotic Side