Foot Health Kits Order Form

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I am a healthcare provider and have a MojoFeet account.

Yes

I am a patient

MojoPro Information

Doctors Name

Clinic Name

Phone Number

Product Order Information

Kits are available in 3 different sizes (according to toe spacers). Please indicate below the size and number of kits to be ordered. Shipping additional and discounts applied for quantities of 6+. Individual kits ordered with a MojoFeet custom orthotic should be using the orthotic order form and will ship with the orthotic with no additional shipping.

Shoe Size

Quantity

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Become a Mojo Pro

Join our campaign of healthcare providers on a journey to change lives through movement. We are fanatical about feet and their role in human health and performance. We realize that strong, functional feet are literally the foundation for a healthy body and an active life.
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Find a Mojo Pro

Our lifts and orthotics can be purchased through our Mojo Pros.
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