Follow the steps to fill out the Surefit L5000 Forms online

1. Click ‘Get Form’ button to access the Surefit L5000 Forms and open it in your preferred online editor.
2. Begin by entering the account number and order date at the top of the form. Ensure to fill in this information clearly and accurately.
3. In the 'Ordered By' section, provide your name or the name of the individual placing the order.
4. Fill out the patient information field, including last name, first name, date of birth, gender, and weight. Please print clearly.
5. Select the appropriate order type by marking the corresponding checkbox for either shoes, diabetic inserts, or other options specified in the form.
6. For custom inserts, please specify the quantity needed and complete the additional options as per your patient's requirements.
7. Ensure to provide current shoe information including brand, style, length, and width. Indicate how the current shoe fits.
8. Fill out the foot measurements section to detail specific foot conditions and any required accommodations.
9. If applicable, circle the accommodation area on the provided imprint or pressure stat and include any comments that may assist the processing of the order.
10. Once all sections of the form have been filled out, review the information for accuracy and completeness.
11. Save your changes when prompted, and then proceed to download, print, or share the completed form as necessary.

Complete your Surefit L5000 Forms online today for a seamless ordering experience!