**While supplies last.

* 1. Are you currently providing Foot Orthotics to your patients?

* 2. If yes, what brand are you currently providing to your patients?

* 3. How many pairs do you typically provide in a month’s time?

* 4. Are you currently using billing codes for insurance on orthotic?

* 5. Would you be interested in an 8 hour CEU course (worth 8 credit hours) on Lower Limb Biomechanics and Orthotic Fitting?

* 6. Do you want a representative to contact you regarding the Vasyli Line of Foot Orthotics?

* 7. Please fill out this information to receive your sample.

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