Diabetic Foot Care Forms

Diabetic Foot Care
Recent changes to Medicare’s Therapeutic Shoe Policy (policy Article A47129) now require more extensive medical documentation.

Please PRINT and COMPLETE the two forms below to be filled out by the physician who manages your diabetes. They are required for your initial evaluation with Scheck & Siress. For more information on diabetic foot care, visit our Orthotic Diabetic Care page.
Click HERE for Diabetic Footwear Forms.

If you need immediate assistance, please call us at 1-866-843-8325. If you have questions, would like to request information about our specific services or would like to make an appointment, please fill out our contact form.