Get Order Assessment Form

The Order Assessment Form is a crucial document for obtaining custom ankle-foot orthoses (AFOs). This guide will assist you in filling out the form accurately and effectively, ensuring that all necessary information is provided to meet the needs of the patient.

Follow the steps to complete the Order Assessment Form online.

1. Press the ‘Get Form’ button to access the Order Assessment Form and open it in your preferred editor.
2. Begin by filling in the work order number and account number, which are often required for processing.
3. Enter the patient's name and shipping address to ensure the AFO is delivered correctly.
4. Provide the patient's diagnosis, height, weight, and age, selecting the appropriate gender.
5. Specify whether the required AFO is for the left, right, or both feet (bilateral).
6. Complete the section for the prescribing doctor or practitioner and include their contact phone number.
7. Indicate the size of the AFO needed, choosing from options such as medium, large, or extra-large.
8. Select the in-office request date to indicate when you expect to receive the AFO.
9. Choose the custom plastic options, padding materials, and thicknesses based on the patient's needs.
10. If applicable, fill in any specific color preferences or closure types for the AFO.
11. Document casting sock replacement needs and any unique instructions related to the anatomical alignment.
12. Make sure to double-check all information before saving, printing, or sharing the completed form.

Complete your Order Assessment Form online today to ensure efficient processing.