Upload File(s) CLINIC INFORMATIONClinic Name* Practitioner Name* Address Phone*Email* PATIENT INFOPatient's Full Name First Last POL Order Form (PDF)*Accepted file types: pdf, zip, Max. file size: 100 MB.Foot Scan Left*Accepted file types: jpg, gif, png, pdf, zip, Max. file size: 100 MB.Foot Scan LeftAccepted file types: jpg, gif, png, pdf, zip, stl, Max. file size: 100 MB.Foot Scan Right*Accepted file types: jpg, gif, png, pdf, zip, Max. file size: 100 MB.Foot Scan RightAccepted file types: jpg, gif, png, pdf, zip, stl, Max. file size: 100 MB.NameThis field is for validation purposes and should be left unchanged. Δ
