Langer - RX Form

After you have casted your patient:

Print and mail the Rx forms which can be downloaded by clicking:

Again, remember to set your Page Setup to "fit to page" before you print.The forms are in Adobe Acrobat format, and can be opened in Acrobat Reader - a free application. You can view and print these RX forms in your web browser by downloading Abobe Acrobat 4.0 for Mac or Windows by following this link to Adobe Acrobat for Mac and PC's

When you send your order to us....

Please submit a new form for each pair ordered, even if for the same patient.
In order to avoid delays in processing, please call ahead with any special instructions.
After making your product selection, indicate any modifications on the form.
Additions and accommodations not ordered initially will incur a repair charge if added later.

Highlighted fields on the Prescription indicate information REQUIRED to process your order. Leaving any of these field blank can delay our processing of your order.

Thank you for using Langer for your prescription orthotics.