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Home
About
The APP
Orthotics
Questionnaire
Contact
Schedule Tele-Eval
Home
About
The APP
Orthotics
Questionnaire
Contact
Schedule Tele-Eval
✕
Home
About
The APP
Orthotics
Questionnaire
Contact
Schedule Tele-Eval
Home
About
The APP
Orthotics
Questionnaire
Contact
Schedule Tele-Eval
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.
Flat Foot
High Arched Foot
Normal Arch
Not Sure
Do you currently suffer from any of the following foot ailments (click all that apply)?
Plantar Fasciitis or heel pain syndrome
Metatarsalgia or ball of the foot pain
Achilles Tendinitis
Ankle pain or frequent sprains/strains
Osteoarthritis
Rheumatoid Arthritis
Bunions
Hammer Toes
Diabetes affecting your feet
Sesamoiditis
Peroneal tendinitis
Morton’s neuroma
General foot pain
Pain from flat feet
Pain from high arches
What activities do you participate in (click all that apply)?
Golf
Tennis
Pickleball
Running
Walking
A job that requires you on your feet a majority of the time
Hiking
Ice skating
Skiing
Other
What type of shoes do you often wear and are seeking support for (click all that apply)?
General athletic (includes running, walking, etc)
Tennis (for tennis or pickleball)
Golf Shoes
Ice Skates
Ski Boots
Dress Shoes (low volume shoes with no removable insoles)
Flats
High heels
Sandals
What is your primary interest in seeking the best orthotics made (choose all that apply)?
Reduce and/or eliminate foot pain
Pain Prevention
Enhance Performance on the fields
Tired Feet
Have you ever worn custom orthotics?
Yes
No
Name
Email Address
Tell us anything else that may be helpful for us to learn
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