Foot & Ankle Center in Seattle
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Phone:  206 344 3808
Address:
600 Broadway
Suite 220
Seattle, WA  98122

DIRECTIONS

Online Appointment Request

Phone:  206 344 3808
Fax:      206 860 0907

Telephone Hours:
Monday—Friday: 
8:00—5:00

Address:
600 Broadway, Suite 220
Seattle, WA  98122

Appointments for Foot and Ankle Problems Seattle
Patient Forms

Order Orthotics



Some common reasons for ordering additional pairs of orthotics include:

  • Orthotics for dress shoes
  • Orthotics for specialty sport shoes
  • Orthotics for sandals

Additional pairs of orthotics can be made from your original molds. In most cases your original mold is stored on computer and is available indefinitely. Occasionally a re-casting may be necessary.

To order additional orthotics, call our office or complete the information below and submit this form. . We will contact you before final ordering of your orthotics to confirm the type of orthotic you are ordering and to go over cost. A deposit is required before ordering the orthotics. Please contact your insurance carrier to confirm coverage for orthotics.

Name:
Address:
City:
State:
Zip:
Contact Phone Number:
Email:
What is the best way
to contact you?
Phone Email
Who is your doctor? Doug Hale Larry Huppin Not sure
What is the number on
the bottom of your orthotics?
If not available, what is
the date that you received them?
Will your insurance cover
another pair of orthotics?
Yes No
Has your insurance or
information changed since
your last visit?
Yes No
 
I would like to order:
 
One pair identical to the last pair
One pair for dress shoes
One pair for Sandals
One pair exclusively for running
One pair exclusively for athletics
One pair exclusively for soccer
One pair exclusively for ski boots
One pair exclusively for racing flats
One pair exclusively for hiking boots
One pair exclusively for bicycling
One pair exclusively for
ice/roller skates
One pair exclusively for other
Comments: 
 
 

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WEBSITE DISCLAIMER
For website errors ONLY email webmaster at WEBMASTER
All pages on this website © 2005-2013
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.

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