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Insole work order form

Fill in the form, draw corrections on the foot diagram and attach photos. Download it as a PDF or send it straight to our laboratory.

1Customer and patient

Company *

Order date

Email *

Phone

First name

Last name

Weight

Age

Shoe size

Indications

Pathology

2Insole type and software

Insole type

Software

EasyCAD 1

EasyCAD 2

3Measurements and elements

Heel cup height

Forefoot thickness

Medial arch height

Lateral arch height

Shoe pitch

Patient insole length

Lift height

Metatarsal pad

Metatarsal bar

Interdigital

Other elements

4Corrections and manufacturing

CAD/CAM insole manufacturing

Block code

Top cover material

Notes

Draw any corrections on the diagram

LeftRight

Draw with a mouse, finger or stylus directly on the diagram.

3D-printed insole manufacturing

Density
Density	HARD	MEDIUM	SOFT
Forefoot
Midfoot
Rearfoot
Elements

Lattice

Left	Forefoot	Rearfoot
Supination	mm	mm
Pronation	mm	mm

Right	Forefoot	Rearfoot
Supination	mm	mm
Pronation	mm	mm

5Photos and images

Photos of the foot, footprint or scan (JPG, PNG, WebP). Photos are resized automatically.

0 / 10

6Download or send

I have read the privacy notice and consent to the processing of the data entered, including the patient's health data, to manufacture the order. I confirm that I have obtained the patient's consent.

To send the form we need the company, an email address and your consent to data processing. The PDF is in the language of this page.