---
title: Medicare Therapeutic Footwear Forms | Priority Footwear
description: Download physician forms required for Medicare coverage of therapeutic footwear and custom orthotics for diabetic patients. Supports medical necessity.
---
[Skip to content](https://www.priorityfootwear.com/medical-forms#main-content)
- [
Find a Location
](https://www.priorityfootwear.com/locations)
- [
Providers
](https://www.priorityfootwear.com/for-professionals)
- Find a Location
- For Professionals
- Help Center
This is a search field with an auto-suggest feature attached.
- There are no suggestions because the search field is empty.
[](https://www.priorityfootwear.com/)
[ ](https://www.priorityfootwear.com)
This is a search field with an auto-suggest feature attached.
- There are no suggestions because the search field is empty.
- [About](https://www.priorityfootwear.com/about-us)
- [Process](https://www.priorityfootwear.com/the-process)
- [Locations](https://www.priorityfootwear.com/locations)
- [Contact](https://www.priorityfootwear.com/contact)
- [Products](https://www.priorityfootwear.com/our-products)
Show submenu for Products
- [Therapeutic Shoes](https://www.priorityfootwear.com/diabetic-footwear)
- [Custom Inserts](https://www.priorityfootwear.com/custom-orthotics)
- [FAQs](https://www.priorityfootwear.com/faq)
- [Providers](https://www.priorityfootwear.com/for-professionals)
- [About](https://www.priorityfootwear.com/about-us)
- [Process](https://www.priorityfootwear.com/the-process)
- [Locations](https://www.priorityfootwear.com/locations)
- [Contact](https://www.priorityfootwear.com/contact)
- [Products](https://www.priorityfootwear.com/our-products)
Show submenu for Products
- [Therapeutic Shoes](https://www.priorityfootwear.com/diabetic-footwear)
- [Custom Inserts](https://www.priorityfootwear.com/custom-orthotics)
- [FAQs](https://www.priorityfootwear.com/faq)
- [Providers](https://www.priorityfootwear.com/for-professionals)
[ ](https://www.priorityfootwear.com/hs/cta/wi/redirect?encryptedPayload=AVxigLLKtfecQ11ZxzOQddKSnyGcKgxUMvg8jt6e2o7F80ICfvVDKeH8DqTyl30COD8Sf%2FmfjPRcPPT%2FijdtfXPrfaqmy2S63hwqU2Dpi1GDdXIYkYafTIwclqe4jr5V52nuOgofK5sXu4tMXddLx12%2FwYKxOF4%3D&webInteractiveContentId=203832010841&portalId=49816697)
- [
For Professionals
](https://www.priorityfootwear.com/for-professionals)
# Medical Provider Forms
Medical forms are provided for physicians and podiatrists to support insurance coverage for therapeutic footwear and custom orthotics for patients with diabetes and qualifying foot conditions. Proper completion of these documents helps establish medical necessity meet insurance requirements and support timely evaluation fitting and dispensing. Priority Footwear manages eligibility verification documentation and coordination to support compliance and continuity of patient care.
Download the medical form.
[ ](https://cta-service-cms2.hubspot.com/web-interactives/public/v1/track/redirect?encryptedPayload=AVxigLJhh1s7EmY73jMIqyStpzLAhKPTZZA3aPx63WaIExu04TasvtzJ09y%2F3wVuzKnd6Fom3oaSvn8xtJ7ijAs7cxlEJ%2F%2F2aWmVgbol2i2IYWhL8mPDsgvkpicS5hZnBhxA2WS94Y8iIbP5HIP0B1TQnhJoORtkuX3U%2BAv%2FSnJ2gsEiyDrcGyHFyPXWtb%2FSNLjJF7lSGHNx8WsPJ7Z3nYstnao6Xzrw8rBPwc7idht8W1cz0AB1Px6oxQPHu1g9Cw%3D%3D&webInteractiveContentId=203939147890&portalId=49816697)
[ ](https://cta-service-cms2.hubspot.com/web-interactives/public/v1/track/redirect?encryptedPayload=AVxigLKw6ryW7Ym49EsjFVUnr6m1S0KIDUx3VI3o%2Ftuoq7rTvwwFbwkcR823aEEFEBaphj7Yszog%2BfcyQ8YK2NenkYfUGRk2w%2FUnXXvZQQAbs6pWI%2BogP1vI4x%2BrIU6KxJQJCek7KqMdHX%2FsED9CLPtoun97X0s%2Byh1fUr%2BGw8q0vGKhwmdLpx4%2FNHdCNsTvllOqSo4ffrGOEEZ4yoB2xDlqnIFwzU6YZ%2BNvzOD0d8bBkiL8t2RAdHcw6nlidlJM&webInteractiveContentId=203939106823&portalId=49816697)
[ ](https://cta-service-cms2.hubspot.com/web-interactives/public/v1/track/redirect?encryptedPayload=AVxigLKvZku%2Fd18njQZeTjL%2BPdE7AcPwuGnHt5T2p512CHBW1zXa9yO4pR5OVZ4P3RDprjmnfBH9wLcvyc3d6LoMZNXG0ozvgVLoIhKeWxCUcPnSwBEuqpK57U8Mk%2BaQsxkFF5lwxNvKusLE9V3JzLljInNp0qTISQoY14fz5iZuEX6ZFo%2BJCsQs1IcBcdC3A6uOCihAdAONFqnvt1IHGVleKygeaRgVGRQZDGiK9zBdTfxjK1tHAyK%2FSmWaktk9LiyN2i%2BOs5csUT8MBg%3D%3D&webInteractiveContentId=207659301283&portalId=49816697)
### Medical Provider Forms
Medical forms are provided for physicians and podiatrists to support insurance coverage for therapeutic footwear and custom orthotics for patients with diabetes and qualifying foot conditions. Proper completion of these documents helps establish medical necessity meet insurance requirements and support timely evaluation fitting and dispensing. Priority Footwear manages eligibility verification documentation and coordination to support compliance and continuity of patient care.
Download the medical form.
[ ](https://cta-service-cms2.hubspot.com/web-interactives/public/v1/track/redirect?encryptedPayload=AVxigLJhh1s7EmY73jMIqyStpzLAhKPTZZA3aPx63WaIExu04TasvtzJ09y%2F3wVuzKnd6Fom3oaSvn8xtJ7ijAs7cxlEJ%2F%2F2aWmVgbol2i2IYWhL8mPDsgvkpicS5hZnBhxA2WS94Y8iIbP5HIP0B1TQnhJoORtkuX3U%2BAv%2FSnJ2gsEiyDrcGyHFyPXWtb%2FSNLjJF7lSGHNx8WsPJ7Z3nYstnao6Xzrw8rBPwc7idht8W1cz0AB1Px6oxQPHu1g9Cw%3D%3D&webInteractiveContentId=203939147890&portalId=49816697)
[ ](https://cta-service-cms2.hubspot.com/web-interactives/public/v1/track/redirect?encryptedPayload=AVxigLKw6ryW7Ym49EsjFVUnr6m1S0KIDUx3VI3o%2Ftuoq7rTvwwFbwkcR823aEEFEBaphj7Yszog%2BfcyQ8YK2NenkYfUGRk2w%2FUnXXvZQQAbs6pWI%2BogP1vI4x%2BrIU6KxJQJCek7KqMdHX%2FsED9CLPtoun97X0s%2Byh1fUr%2BGw8q0vGKhwmdLpx4%2FNHdCNsTvllOqSo4ffrGOEEZ4yoB2xDlqnIFwzU6YZ%2BNvzOD0d8bBkiL8t2RAdHcw6nlidlJM&webInteractiveContentId=203939106823&portalId=49816697)
[ ](https://cta-service-cms2.hubspot.com/web-interactives/public/v1/track/redirect?encryptedPayload=AVxigLKvZku%2Fd18njQZeTjL%2BPdE7AcPwuGnHt5T2p512CHBW1zXa9yO4pR5OVZ4P3RDprjmnfBH9wLcvyc3d6LoMZNXG0ozvgVLoIhKeWxCUcPnSwBEuqpK57U8Mk%2BaQsxkFF5lwxNvKusLE9V3JzLljInNp0qTISQoY14fz5iZuEX6ZFo%2BJCsQs1IcBcdC3A6uOCihAdAONFqnvt1IHGVleKygeaRgVGRQZDGiK9zBdTfxjK1tHAyK%2FSmWaktk9LiyN2i%2BOs5csUT8MBg%3D%3D&webInteractiveContentId=207659301283&portalId=49816697)
If you have questions about forms or the process, contact:
Priority Footwear
10240 SW Nimbus Ave Ste L1
Portland, OR 97106
1-866-557-3478
info@priorityfootwear.com
ABOUT US
- [About](https://www.priorityfootwear.com/about-us)
- [Process](https://www.priorityfootwear.com/the-process)
- [Locations](https://www.priorityfootwear.com/locations)
- [Medical Forms](https://www.priorityfootwear.com/medical-forms)
- [Providers](https://www.priorityfootwear.com/for-professionals)
FOOTWEAR
- [Products](https://www.priorityfootwear.com/our-products)
HAVE A QUESTION?
- [Find A Location](https://www.priorityfootwear.com/locations)
- [Contact Us](https://www.priorityfootwear.com/contact)
- [FAQs](https://www.priorityfootwear.com/faq)
**CONTACT**
Mon - Fri: 9:00am - 5:00pm PST
Sat - Sun: Closed
- (866) 557-3478
- [
info@priorityfootwear.com
](mailto:info@priorityfootwear.com)
- Portland, Oregon
-
-
[ ](https://www.priorityfootwear.com)
`Notice of Privacy Policy | Privacy Policy | Patient Bill of Rights | Cookies Policy | Terms of Use | Notice of Good Faith`
Copyright © 2026 Priority Footwear. All Rights Reserved.
```json
{
"@context" : "https://schema.org",
"@type" : "Organization",
"description" : "Clinic based fittings for Medicare covered diabetic shoes and custom orthotics across the Pacific Northwest.",
"logo" : "https://www.priorityfootwear.com/assets/logo.png",
"name" : "Priority Footwear",
"sameAs" : [ "https://www.facebook.com/priorityfootwearofficial", "https://www.instagram.com/priorityfootwear" ],
"telephone" : "+1 866 557 3478",
"url" : "https://www.priorityfootwear.com/"
}
```
```json
{
"@context" : "https://schema.org",
"@type" : "MedicalOrganization",
"description" : "Clinic based fittings for Medicare covered diabetic shoes and custom orthotics across the Pacific Northwest.",
"knowsAbout" : [ "Orthotics", "Diabetic Footwear", "Custom Orthotics" ],
"logo" : "https://www.priorityfootwear.com/assets/logo.png",
"medicalSpecialty" : "Endocrine",
"name" : "Priority Footwear",
"sameAs" : [ "https://www.facebook.com/priorityfootwearofficial", "https://www.instagram.com/priorityfootwear" ],
"telephone" : "+1 866 557 3478",
"url" : "https://www.priorityfootwear.com/"
}
```
```json
{
"@context" : "https://schema.org",
"@type" : "WebSite",
"name" : "Priority Footwear",
"potentialAction" : {
"@type" : "SearchAction",
"query-input" : "required name=search_term_string",
"target" : "https://www.priorityfootwear.com/?s={search_term_string}"
},
"url" : "https://www.priorityfootwear.com/"
}
```
```json
{
"@context" : "https://schema.org",
"@type" : "BreadcrumbList",
"itemListElement" : [ {
"@type" : "ListItem",
"item" : "https://www.priorityfootwear.com/",
"name" : "Home",
"position" : 1
}, {
"@type" : "ListItem",
"item" : "https://www.priorityfootwear.com/medical-forms",
"name" : "Medical Forms",
"position" : 2
} ]
}
```
```json
{
"@context" : "https://schema.org",
"@type" : "BreadcrumbList",
"itemListElement" : [ {
"@type" : "ListItem",
"item" : "https://priorityfootwear.com",
"name" : "Home",
"position" : 1
}, {
"@type" : "ListItem",
"item" : "https://priorityfootwear.com/medical-forms",
"name" : "Medical Forms",
"position" : 2
} ]
}
```