Most fields are optional. Feel free to ignore fields for up-to-date information you have already given us. Any further details you can add will help us serve you or work with you better.
We deem the information from here to the end of "More About Your Feet" as "sensitive information" for privacy-related purposes. If you enter details in these sections, you will need to provide a "Sensitive Personal Information Usage Consent" at the end of the form.
Would you like us to phone or visit you to discuss our services in more detail?
(Topics can include anything you may wish to discuss, including any of the following: DVA Medical Grade Footwear process; discussion or inspection of MGF styles; remote fitting of shoes; discussion or inspection of non-MGF comfort footwear styles; use of digital scanners in assessing footwear needs; our Visitation Service; podiatrist information sessions; making the best use of our website to assist your clients; information we can send you; and receiving our news updates for podiatrists.)
We sometimes consider buying remaining wholesale stock of discontinued styles, especially if this involves footwear we have already stocked, a discounted wholesale price and/or comfort footwear features that are difficult for us to provide to customers using other available styles. We would appreciate your advice about any of your current footwear that meets this description.
Upload up to 2 photos or scans showing tracings of your feet. For instructions, see http://justcomfortshoes.com.au/foot-tracings (opens in a new window).
Upload up to 4 photos of your feet using the 4 Upload buttons below.