Please include:

• Personal details
  Name, date of birth, phone numbers, NHI, ethnicity (if Crown funded), ACC number (if applicable)
• Primary Diagnosis and Other Diagnoses especially if these have any bearing on the treatment. For example: Foot Ulcer, Type I Diabetes
• Prescription Goal – what do you hope to achieve?  
• Detailed description of the type of Orthosis required.  

The more information you provide, the better we understand what you want!

Orthotic Centre prescription pads are available.  Please use them - especially in the public hospitals.  However, if you do not have one, the above details on your business letterhead is sufficient