Assesment

Step 1 of 6 Personal Information

Personal Information

Full Name *

Age Range *

Sex *

Email Address *

Phone Number *

Preferred Contact Method *

Main Concern

Symptoms

How long has this been occurring? *

Which foot is affected? *

Pain / Discomfort Level: 5/10

Describe Your Symptoms *

Lifestyle & Activities

Which activities are affected?

Walking Standing Running Sports Exercise Work Activities Daily Activities Sleep

How active are you? *

What type of footwear do you wear most often? *

Medical History

Have you been diagnosed by a healthcare professional? *

Have you previously seen a podiatrist? *

Are you currently receiving treatment? *

Do you have diabetes? *

Additional Medical Information

Review & Submit

Thank you for completing the questionnaire. Based on your responses, we'll identify the products in our collection most commonly used for your condition category and send them to the email you provided. Please allow up to 1 business day.

Preliminary Match

Your preliminary support pathway will appear here

Complete the assessment and this section will summarize the closest support category before submission.

Suggested Support

Why this matched

This is not a diagnosis. It is a preliminary support match based on your answers and should be reviewed by Dr. Menke and his team before final recommendations are made.