M9 Prescription Variables

    Left
    Right

    Both Feet

    Units

    1. Shoe Size (Please Note: we always convert this to a "mm" measure)

    or

    UK/mm

    2. Maximum Forefoot Width (bisecting 1st and 5th met markings)

    or

    mm

    3. Maximum Heel Width (bisecting plantar heel markings)

    or

    mm

    4. Peak medial arch height

    or

    mm

    5. Peak lateral arch height

    or

    mm

    6. Intrinsic Rear foot post angle (medial/ lateral)

    or

    deg °

    7. Forefoot / Shell Thickness

    or

    mm

    8. Standard Topcover:

    9. Standard Midlayer:

    Practitioner First Name

    Practitioner Surname

    Practitioner Current Registration Number

    Your work email

    Patient Reference Number

    Delivery Address

    Delivery Postcode

    Your Notes to Design Team (optional)

    I have read and agree to the Footprint Hub terms of service.