Break-In instructions for new shoes.

Congratulations on receiving your new shoes. In accordance with Medicare regulations, they have been selected from our own inventory, from another company or have been fabricated to provide you with optimum comfort and protection. In order to receive the greatest benefits from this footwear, please follow these suggested guidelines.

Getting used to your shoes
People with decreased feeling in their feet may have a false sense of security as to how much at risk their feet actually are. An ulcer under the foot can develop in a couple of hours even if the shoes are expertly fit. In order to best avoid any irritation, please adhere to the following break-in schedule:

FIRST DAY

Wear One Hour

SECOND DAY

Wear Two Hours – Check feet after first hour

THIRD DAY

Wear Three Hours

FOURTH DAY

Wear Four Hours – Check feet after two hours

FIFTH DAY

Wear Full Day – Check after lunch

  • IF AT ANY TIME YOU SEE RED SPOTS OR DARKNESS ON THE TOES OR OTHER BONY AREAS DURING THE FIRST FIVE DAYS: Discontinue wearing the shoes for the rest of the day and start routine again the next day beginning with one hour of wear.
  • IF A RED SPOT OR DARKNESS APPEARS WITH EVERY WEARING – PLEASE DO NOT WEAR SHOES. Call  ____________________ at (_____)________________  for an adjustment appointment.
          
          (name of practice)
                  
  • BE SURE TO INSPECT YOUR FEET EVERY DAY.

Follow-Up
You should have regularly scheduled visits with ________________. Please direct any questions about the items received today to this office. Billing questions may be directed to your Medicare carrier. Every four months get rid of the inserts in your shoes and put in a new pair. In one year, you will receive a reminder to return to __________________ to evaluate the condition of these shoes.

                                             
Return Policy
Shoes that are unsuitable may be returned within four weeks of dispensing. The shoes must be in good condition, i.e., no scuffmarks, outside dirt or obvious wear on the soles. We strongly urge you to wear these shoes in your home for the first week. Substandard shoes may also be returned as all warranties, expressed and implied under applicable State law will be honored.

I certify that I have received the item(s) marked below in good condition. The Practitioner has explained, in detail, the proper use and care of this device and has fit it to me. The Practitioner has asked me to call the office if I encounter any problems with the device or if I have any questions. I have been informed of the Medicare DMEPOS Supplier Standards.

Name:_____________   Signature:_______________________

Date___________

Qty:____  Manufacturer:____________  Description:____________________

Size:_____Width:_____

Qty:____  Manufacturer:____________  Description:____________________

Size:_____Width:_____

     
Original: To Patient      Copy: To Patient File      Faxed Date:______________________

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