Diabetic Shoes

As a Medicare Patient you may qualify for one pair of diabetic shoes per calendar year through the Therapeutic Shoes for Diabetics Program.

Florida Pedorthics Intake Form

Use the form below to provide our office with your information to begin preparing the necessary documents to qualify you for diabetic shoes and inserts through Medicare.

Today's Date*
MM slash DD slash YYYY
Your Full Name*
Name First and Last
Date of Birth*
Month
Day
Year
Phone*
Your email address
Name of Primary Insurance*
Name of Secondary Insurance if Applicable
Name of Physician Treating Diabetes*
First and Last Name
Please provide the name of your Podiatrist if you see one
First and Last Name