Semi-Custom, Pre-MadeOrthotech Laboratory

Semi-Custom, Pre-Made

Selection:
Semi-CustomPreMade

Podiatrist
Name:
Phone:
Clinic:
Email:
Address:
Date:

Semi-Custom - (Info)
Patient Name:
Design:
Rear Foot:
04812
Arch Height:
LowMedHigh
Grind:
NormNarrowWideCourtHookHook (Full Heel Cover)
Size (mm):
A(105)B(115)C(125)D(135)E(145)F(155)G(165)H(175)I(185)J(195)K(205)L(215)

Return Required - (Info)
StandardExpress
Required Date:

Shell Material - (Info)

Yes Polly (mm)

2344.55Other

Yes Composite (mm)

1.92.32.73Other

Yes EVA (3/4 shell)

Very SoftSoftMedFirmVery Firm
Yes Trilaminate(diabetic)

Yes Subortholene

2mm3mm4mm

Additions - (Info)
Left/Right
L
R
Rear Foot Post:
Yes
Yes
Poron/Eva & Density:
Heel Cup Depth:
Heel Lift(mm):
FHSA:
Yes
Yes

Additions - (Info)
Left/Right
L
R
Met Dome:
Yes
Yes
1st MPJ Cutout:
Yes
Yes
1st RAY Cutout:
Yes
Yes
PFA(mm):
Mortons Extension:
Yes
Yes
Shell/Poron/Eva:


Medial Flange:
Yes
Yes
Lateral Flange:
Yes
Yes
Arch Fills:
Yes
Yes
Poron/Eva&Density:
Calcaneal Cutout(mm):
Out Toe Gait Plate:
Yes
Yes
In Toe Gait Plate:
Yes
Yes

Cover Length - (Info)

MetsSulcusF/L

Poron - (Info)

1.6mm3.2mm6.4mm

ShellExtensionS&E

Covers - (Info)

Personalised CoverVinylLeatherAMBNeopreneSuedeEVAPerf. EVAPS VliesPlastizoteNo Cover

SmoothRought


Thickness/Colour:

Pre-Made Orthotics - (Info)

HAND MADE and AUSTRALIAN MADE

Please use this section if you wish to keep a selection of hand-made, pre-made orthotics in stock.

The premade range orthotics are 4 degree rear-foot with medium arch control. This is our most popular semi-custom device. For variations in rear-foot control or arch height please use the other section.

Please enter the quantity of each that you would like below:

Size 2 3 4 4.5
A(105)
B(115)
C(125)
D(135)
E(145)
F(155)
G(165)
H(175)
I(185)
J(195)
K(205)
L(215)
2.3 2.7
soft med firm



Black Vinyl CoverNo Cover

Notes

(yes/no)