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ORTHOTIC WARRANTY ENROLLMENT FORM return this portion with your payment Date Orthotic Number Name Address City State Zip Credit Card Telephone Exp. Date Card Code ATTENDING HEALTH CARE PROVIDER enclosed is my check or credit card information for payment of 60. ENROLLMENT in the Biomechanical Services Orthotic Warranty Program will provide for repair or replacement of the orthoses made for Account Name Patient Name Orthotic No. THE BENEFITS of this warranty program take effect once we receive...

How to fill out the othotic group warranty form

How to fill out Orthotic Warranty Enrollment Form

1. Obtain the Orthotic Warranty Enrollment Form from your provider or manufacturer.
2. Fill in your personal details, including your name, address, and contact information.
3. Provide details about the orthotics, including the type, size, and serial number.
4. Include the purchase date and the name of the vendor from whom you bought the orthotics.
5. Sign and date the form to confirm that all information is accurate.
6. Submit the completed form to the designated warranty department electronically or via mail according to the instructions provided.

Who needs Orthotic Warranty Enrollment Form?

1. Individuals who have purchased or received orthotic devices that are covered under a warranty.
2. Healthcare providers who want to ensure their patients' orthotic devices are enrolled for warranty protection.
3. Families or caregivers of patients using orthotic devices to manage warranty claims efficiently.

Video instructions and help with filling out and completing warranty orthotic

Instructions and Help about orthotic warranty form

If you suffer from sore aching feet take heart if just doing your job makes walking and standing painful get ready for a change introducing the new walk fit platinum orthotics guaranteed to get you back on your feet pain-free more than 5 million people already know the benefits of the original walk fit with its biology heel cup to steady and strengthen your heel and ankle the longitudinal and metatarsal arch supports to distribute your weight and add balance, and its flexible action to cushion and return energy to the feet but the new walk fit platinum does even more first it's enhanced with NATO silver an antibacterial agent to resist and kill germs and order than to help guarantee your comfort we've added shock relief our impact resistant gel heel pad for added cushioning and protection unlike ordinary cushions and pads that offer little support your feet actually conform to the walk fit moving ligaments tendons and muscles into more supportive positions remember when your feet are off your whole body is off, and you're like this unstable tower of blocks walking even standing can be painful but walk fit is engineered to help align your feet spine and pelvic area, so we're not just fixing a foot problem we're fixing a body problem to look at the results of this independent clinical study by doctors over ninety percent got pain relief in their feet knees hips and back when using walk fit orthotics just imagine being able to enjoy things like dancing bowling taking a walk or just going shopping without pain available in sizes for men and women the walk fits fit most shoes and with our patented customizable inserts are comfortable whether you have high medium or low arches light and washable they also have specially designed air vents to help keep your feet cool and made of a virtually indestructible co polymer resin they come with a lifetime replacement warranty so take a step in the right direction to let walk fit platinum help put fun back in you life

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What is Orthotic Warranty Enrollment Form?

The Orthotic Warranty Enrollment Form is a document used to register orthotic devices for warranty coverage.

Who is required to file Orthotic Warranty Enrollment Form?

Patients receiving orthotic devices and healthcare providers who dispense these devices are typically required to file the form.

How to fill out Orthotic Warranty Enrollment Form?

To fill out the form, you need to provide patient information, details of the orthotic device, and any relevant billing information.

What is the purpose of Orthotic Warranty Enrollment Form?

The purpose of the form is to ensure that the orthotic device is covered under warranty, providing protection against defects or issues that may arise.

What information must be reported on Orthotic Warranty Enrollment Form?

The information that must be reported includes patient name, device serial number, date of purchase, provider details, and warranty terms.