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Type of shoes

General questions

Points of pain

Your product

In what type of shoes do you want to insert the orthotics?

I am asking this in order to correctly adjust the structure of the orthotics to your shoes. You can choose more than one pair of shoes.

Elegent Boots

Work Boots

What is your weight?

Above 180 Pounds

Below 180 Pounds

I am asking this in order to create orthotics with the best design and thickness for you.

Do you have diabetes?

Yes

No

Certain types of diabetes indicate the need for softer orthotics.

Is there any pain in these areas of your body?

Lower back

Knees

Feet

No pain

The information will be used in order to customize the product for you and relieve your pain. If there is no pain, that’s excellent.

Does the pain radiate into your legs / buttocks?

Yes

No

The information is important for the correct diagnosis of the source of the pain and the required treatment.

When is the pain felt?

After standing up for a long time

End of the day

during exerted effort

After standing up/lying down for a lengthy period

The time that the pain appears is very important for the correct diagnosis of the problem.

Where is the knee pain felt?

The external area of the knee

The internal area of the knee

The location of the knee pain indicates body posture.

How many warts do you have?

minus

plus

is shorter by: (Millimeters)

minus

plus

Is there any other important information I should know?

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