PLEASE NOTE: First two sections are to be completed by your clinician. Podiatrists Notes (To be completed by CLINICIAN): Appointment Date * MM DD YYYY Name * First Name Last Name Manufacture Time * Standard (5 Days) Number of Pairs * Size * First Steps Daily FSD Arch Profile * F N Length 3/4 Sulcus Full Top Cover Options PPT with Durafit Smooth Top Cover PPT with Durafit Suede Top Cover 2mm Black EVA 1mm EVA with Durafit Smooth Top Cover 1mm EVA with Durafit Suede Top Cover Modifications & Paddings Medial Arch Pad - LEFT (mm) Medial Arch Pad - RIGHT (mm) Medial Arch Pad PPT EVA Heel Cushion Pad - LEFT (mm) Heel Cushion Pad - RIGHT (mm) Heel Cushion Pad PPT EVA Neuroma Pad - LEFT (mm) Neuroma Pad - RIGHT (mm) Neuroma Pad PPT EVA To be completed with finished top cover only - no backing Thank you.You will receive your orthotics within 10-14 working days from your appointment via Royal Mail. If you would like an update on the status of your orthotics, please email pa@expertpodiatry.co.uk
