Have there been any changes to your Family Medical History or your own Medical History?
Do any of the following conditions run in your family:
Rheumatoid Arthritis/ Osteoarthritis/ Osteoporosis/ Diabetes/ Hypermobility Syndromes (e.g. Ehlers-Danlos syndrome)
- Skin conditions such as Psoriasis can have important and relevant implications in some lower limb conditions. Please make us aware of such skin conditions.
Please tell us about any changes or updates to your medications:
Please list your current medication (if any) here. Please include daily dose, when you started the medication and for what reason the medication was prescribed. If you prefer - you can bring your prescription form along to your appointment.
Are you returning to replace or service your current Foot Orthoses? NO YES YES, but I need to report new symptoms
If you have no new symptoms and just need an update to your foot orthoses simply select YES here. Alternatively, you can select YES and continue the form to report new symptoms.