M9 Prescription Variables
1. Shoe Size (Please Note: we always convert this to a "mm" measure)
—Please choose an option—32.53333.5343535.53636.537.538.53939.54040.5414242.543.54444.54545.546.54747.548.54949.5505151.55252.5535454.555---200205210215220225230235240245250255260265270275280285290295300305310315320325330335340345350355360365370375380
UK/mm
2. Maximum Forefoot Width (bisecting 1st and 5th met markings)
—Please choose an option—404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110
mm
3. Maximum Heel Width (bisecting plantar heel markings)
—Please choose an option—404142434445464748495051525354555657585960616263646566676869707172
4. Peak medial arch height
—Please choose an option—0123456789101112131415
5. Peak lateral arch height
6. Intrinsic Rear foot post angle (medial/ lateral)
—Please choose an option—012345678910111213141516
deg °
7. Forefoot / Shell Thickness Nylon PA11 (3/4 Length)Nylon PA12 (3/4 Length)
—Please choose an option—1.51.61.71.81.922.12.22.32.42.52.62.72.82.933.13.23.33.43.53.63.73.83.944.14.24.34.44.54.64.74.84.955.15.25.35.45.5678910
8. Standard Topcover: No Topcover Black Yampi Synthetic Leather (add €6) Other (add €12, detail below):
9. Standard Midlayer: No Midlayer Poron 4000 @ 1.5mm (add €6) Other (add €12, detail below):
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)
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