What is an orthotic prescription form?

It's the form a practitioner sends to a custom orthotics lab with the device specification and the patient, shoe and clinic details the lab needs to make the orthotics. At Orthix, clinics complete it online in the Orthix app.

Is an orthotic order form the same as a prescription form?

The terms are often used interchangeably. The prescription is the practitioner's device specification (type, shell, posting, top cover and additions). The order form wraps it with patient, shoe, clinic and shipping details.

What should an orthotic prescription include?

Patient details and measurements, the side, shoe type and heel height, device type and length, shell material and flexibility, posting with amounts, top cover, additions, clinical notes, the capture or impression, and the practitioner's name and designation.

Do you have a printable orthotic prescription form?

No. Orthix clinics order online in the app. Contact the lab at +1 (604) 447-2880 or info@orthix.ca if you have questions.

Can we send foam impressions?

Yes, foam impressions are accepted as a secondary option. Most Orthix orders are placed online: you capture both feet on a phone or iPad, and the app generates a 3D model.

How long does an order take after we submit?

The lab reviews each order first. Typical fabrication is 5–10 days after lab acceptance, then the orthotics ship to your clinic. Shipping time depends on destination and courier, and Lower Mainland clinics can use pickup or courier.

Orthotic Prescription Form and Order Form for Clinics

An orthotic prescription form (often called an orthotic order form or Rx form) tells a custom orthotics lab what to make: the patient's details, the shoe, the device, posting, materials, top cover, additions and who prescribed it. At Orthix, clinics don't fill in paper. The online assessment in the Orthix app is the prescription form, and the app generates a 3D model to go with it.

Order online in the Orthix app instead of paper

Complete the online assessment. It's a structured digital order form, and drafts save until you're ready.
Capture both feet on a phone or iPad.
The app generates a 3D model. Review it before you submit.
Submit the order and track it online.

Typical fabrication is 5–10 days after lab acceptance. No dedicated scanner is needed (orthotic scanner options compared). Foam impressions are accepted as a secondary option. See Orthix software for the full workflow.

What an orthotic prescription form includes

Lab prescription forms vary, but most ask for the same information. Use this as a checklist whether you order online or on paper.

Section	What it covers
Practitioner and clinic	Practitioner name and designation, clinic name, phone, email, shipping address, order date
Patient details and measurements	Patient name or ID, shoe size and width, foot length if measured, body weight, activity level
Side	Left, right or both, and any differences between them
Capture method	3D model from phone or iPad capture, or a foam impression
Shoe type	The footwear the device must fit (dress, casual, athletic, work or safety boots), heel height, and whether the insole is removable
Device type and length	Device family, plus full length, sulcus length or 3/4 length
Shell and materials	Shell material and flexibility (for example flexible, semi-rigid or rigid)
Posting	Rearfoot and forefoot posting: varus or valgus, amount in degrees, intrinsic or extrinsic
Top cover	Top cover material, thickness and length
Additions	Metatarsal pad or bar, heel lift, heel cup depth, cut-outs or accommodations, extensions
Clinical notes	Presentation and goals, prior orthotics and what didn't work, pressure areas, instructions for the lab

In the Orthix app, these details go into the online assessment and order, so nothing gets lost between paper, email and courier.

All modifications you prescribe on an Orthix order are included at no extra cost. See orthotic modifications and additions, or compare functional vs accommodative orthotics.

Orthotic prescription form vs order form

The two terms are often used interchangeably, and many labs combine them on one page or PDF.

Prescription (Rx): the practitioner's device specification: device type and length, shell, posting, top cover, additions and clinical notes.
Order form: the prescription plus everything the lab needs to make and ship the order: patient and practitioner details, capture method, shoe type and the clinic's shipping address.

At Orthix, both go into one online assessment, so you enter them once.

How to write an orthotic prescription

Start from your assessment findings and the patient's goals.
Name the shoe the device has to fit, including heel height.
Choose the device type and length.
Specify the shell material, flexibility and posting, with amounts.
Add the top cover and any additions, saying where they go and how much.
Write notes for the lab: prior devices, pressure areas and anything unusual.
Check the capture or impression matches the patient and side, then add the practitioner's name and designation.

This is general guidance for clinic teams, not clinical advice. Prescription decisions stay with the practitioner. For device selection, see the custom orthotic prescription and device-selection guide.

Prescription form mistakes that hold up orders

No shoe type or heel height, so the lab can't fit the device to the footwear
Posting named without an amount, or without saying rearfoot or forefoot
Additions listed without a position or size
Left and right differences not marked
Top cover length missing
A capture or impression that doesn't match the patient or side
Practitioner name or designation missing

Each of these can mean a message from the lab before it accepts the order. Our guide to orthotics lab turnaround time explains why acceptance, not submission, starts the clock.

Printable prescription form

Orthix doesn't use a paper prescription form. Order online in the Orthix app, or contact the lab at +1 (604) 447-2880 or info@orthix.caif you'd like to talk about sending foam impressions.

Ordering on paper with another lab today? See how to switch orthotics labs.

Order from a Canadian orthotics lab

Orthix is a custom orthotics lab in Canada, based in Vancouver, BC, that supplies clinics across the country: physiotherapists, chiropractors, podiatrists, chiropodists and pedorthists. We work only with clinics and practitioners, never directly with patients. Finished orthotics ship to your clinic. See orthotics lab shipping across Canada.

FAQ

What is an orthotic prescription form?: It's the form a practitioner sends to a custom orthotics lab with the device specification and the patient, shoe and clinic details the lab needs to make the orthotics. At Orthix, clinics complete it online in the Orthix app.
Is an orthotic order form the same as a prescription form?: The terms are often used interchangeably. The prescription is the practitioner's device specification (type, shell, posting, top cover and additions). The order form wraps it with patient, shoe, clinic and shipping details.
What should an orthotic prescription include?: Patient details and measurements, the side, shoe type and heel height, device type and length, shell material and flexibility, posting with amounts, top cover, additions, clinical notes, the capture or impression, and the practitioner's name and designation.
Do you have a printable orthotic prescription form?: No. Orthix clinics order online in the app. Contact the lab at +1 (604) 447-2880 or info@orthix.ca if you have questions.
Can we send foam impressions?: Yes, foam impressions are accepted as a secondary option. Most Orthix orders are placed online: you capture both feet on a phone or iPad, and the app generates a 3D model.
How long does an order take after we submit?: The lab reviews each order first. Typical fabrication is 5–10 days after lab acceptance, then the orthotics ship to your clinic. Shipping time depends on destination and courier, and Lower Mainland clinics can use pickup or courier.
Who can order from Orthix?: Clinics and practitioners across Canada, including physiotherapists, chiropractors, podiatrists, chiropodists and pedorthists. Orthix doesn't sell to patients.

Ready to order online?

Orthix · 101A-8380 St. George St, Vancouver, BC V5X 3S7 · +1 (604) 447-2880 · info@orthix.ca