Get Diabetic A5513 Orthotic Order Form - Bamfitb Inc

Filling out the Diabetic A5513 Orthotic Order Form online is a straightforward process that ensures your orthotic needs are met efficiently. This guide will walk you through the necessary steps to complete the form accurately, providing clarity on each section.

Follow the steps to fill out the Diabetic A5513 Orthotic Order Form online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the store location and contact information, including the date, store number, and Amfit account number.
3. Complete the shipping details by entering the phone number, contact name, email address, and any other necessary details.
4. Ensure to send the original form inside the foam box as indicated.
5. Provide patient information by filling out the first name, middle initial, last name, sex, and shoe size.
6. Insert the thickness of the orthotic for both the left and right sides, selecting measurements between 2-4 mm.
7. Select the required style and quantity of orthotics by checking the appropriate boxes for the desired options.
8. Fill out the standard adjustment options, providing angles in degrees for medial and lateral wedges, as well as measurements for the metatarsal pad.
9. Indicate any required depressions or cutouts by drawing on the appropriate foot, specifying sizes and depth in millimeters.
10. Include any special instructions or notes that may help fulfill your order.
11. Review all filled sections for completeness and accuracy, ensuring that no fields are left blank.
12. Once all information is confirmed, users can save changes, download, print, or share the completed form as needed.

Start filling out the Diabetic A5513 Orthotic Order Form online now to ensure timely processing and delivery.