Please fill out the  information form below,
                                         and fax this page to Orthofeet Inc.
                                                     at: 201-767-6748

Free Medicare Billing

 

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 the Orthofeet Free Medicare Billing Program, please print it out,

sign it, and fax it to us at: 201-767-6748. 

 

Name:__________________________________________________________

Title:___________________________________________________________

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Address:________________________________________________________

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Phone:________________________ Fax:_____________________________

E-mail:_________________________________________________________

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