Forms for Therapists

Here you will find forms that you need to order our products. If you have any questions contact us or eMail thrive@wellandable.com.au.

If you require a MS Word version of any of these forms to make it easier to complete please eMail us, quote the form name and we will send it to you.

Completed forms need to be sent to thrive@wellandable.com.au.

Footwear

NIMCO, Schein and Duna footwear measurement form

NIMCO, Schein and Duna footwear require additional measurements to be taken to ensure the correct size is selected. It is preferred that these forms are completed by your therapist to ensure the correct measurements are taken.

 

Note: custom made products are not able to be returned.

Aurelka Shoe Orthoris - 1033 and 1038

This form is required to be completed to place an order for the Aurelka Shoe Orthosis. It is preferred that these forms are completed by your therapist to ensure the correct measurements are taken.

 

Note: custom made products are not able to be returned.

Split pairs

Duna is able to offer a split pair, whereby a pair of shoes of the same style are supplied, but one shoe of the pair accommodates the users orthosis and the other accommodates the users foot. Complete the “NIMCO, Schein and Duna footwear measurement form” above and ensure you indicate that a split pair is required.

 

Note: custom made products are not able to be returned.

 

Gaiter

Gaiters Order Form

Complete this form to order a custom made gaiter. It is preferred that these forms are completed by your therapist to ensure the correct measurements are taken.

Note: custom made products are not able to be returned.

Fabric Options for Gaiters

This provides a list of the current fabric options for gaiters as at June 2019. Availability of these fabrics depends on our supplier and will be confirmed at time of ordering.

 

Miscellaneous

Clinic request form

If you would like to arrange for Well & Able to run a clinic at your location complete this form and sent it to thrive@wellandable.com.au. We will contact you to determine when the clinic would be run.

Note: there are minimum numbers of clients required for clinics.

Confirmation of supply of assistive technology

This form is required to be completed to confirm the supply of assistive technology.