Guaranteed relief of pain or your money back!
Order Form


First pair: $199.00
Additional pairs $132.00

Internet Special
FREE shipping and handling
a $9.95 value.

Have you ordered from us before? Enter your customer ID number here.

 

FIRST PAIR -- $199.00
Please choose the type of orthotic you wish to purchase.

Click HERE to see the different types of Orthotics.

Additional Information:

The following information will help us fabricate your custom orthotic better:
Age:
Sex:
Weight:
Shoe Size:
Type of foot (pick one):
Location of pain or problem:
Additional comments:


1st ADDITIONAL PAIR -- $132.00
To order additional sets of orthotics, please choose a type of orthotic you wish to purchase below.

Type:
Click HERE to see the different types of Orthotics.




2nd ADDITIONAL PAIR -- $132.00

Type:
Click HERE to see the different types of Orthotics.




 

3rd ADDITIONAL PAIR-- $132.00

Type:
Click HERE to see the different types of Orthotics.




All information is confidential and will not be released without your permission.

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