Orthofeet is offering you the simplest, most efficient Medicare billing, for FREE!  

The Free Billing is offered when you order a package of one

pair of diabetic shoes and three pairs of diabetic inserts, which are billed to Medicare.

To register to this program, please fill out the information form below, print it out, sign it, and fax it to us at: 201-767-6748. 

Name:___________________________ Title:______________

Name of Business:____________________________________

Address:____________________________________________

City:___________________ State:____ Zip Code:__________

Phone:____________________ Fax:_____________________

E-mail:_____________________________________________

Signature:__________________________________________

For print friendly format click here