Client File

Please fill out the following form to submit your client information to Progressive Step Orthotics and Bracing. If you would prefer to print this document please click the pdf button below to download it.
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Client File

Parent/Guardian Information

If you are under 19 please input your Parent/Guardian Information.

Please Note

If you have clicked YES and decide to go ahead with orthotics, please don’t send anything to your extended healthcare providers until your final appointment, as we will be giving you an entire package with all the information that they require, as it pertains to your visit with us. 
If extended health package is lost or misplaced, we will replace it for a $20.00 charge.

Important Information

Orthotic prices vary to match the individual personal needs. Typically, orthotic fees range from $485.00-$550.00.  This price includes fabrication of the orthotics, fitting of the orthotics and any adjustments, if required.  There is a one-time $75.00 fee for the biomechanical evaluation and assessment.

We are committed to providing the best support for every patient. If proceeding with orthotics, due to the custom nature of the work, a non-refundable deposit of 50% is required. Please appreciate the human body is very dynamic and it is difficult to guarantee outcomes; as such there are no refunds, exchanges or credits for custom products/services. If you have any questions please discuss them with your Pedorthist. *Orthotics will NOT be dispensed without a referral from a physician. **Orthotics not picked up after 90 days will no longer be held.

We cannot share your information. Your file is private and confidential and only with your consent can we share your information regarding your file with your Doctor.

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