Request Information | MiracleBrace

Thank you for your interest in MiracleFeet’s products and/or services.

Other questions or inquiries about the MiracleFeet brace? Please email us.

We are open to Technical Assistance Partnership applications from prospective Ponseti trained partners who provide clubfoot treatment to children. These partnerships could involve supply of the MiracleFeet Foot Abduction Brace (FAB), use of the CAST App/CAST Community Support, and/or support with training. Qualified Partners providing services to low income children are eligible to receive the MiracleFeet Foot Abduction Brace for free or at sharply discounted prices.

To evaluate a prospective partnership, we need to know more about your clubfoot treatment work. Please answer the questions below and return this application to MiracleFeet. The more detailed and complete your answers, the easier it will be to process your application.

MiracleFeet Prospective Technical Assistance Partner Application

General Information
Clinic Data
Support Request

Personal Information

Name

Profession

Date

Clinic Information

What is the name and address, including country, of the clubfoot clinic where you work?

Clinic Name

Clinic Address

What is your role in this clubfoot clinic?

Any potential agreement must be signed by the accountable manager responsible for the clubfoot clinic.

Please describe the clubfoot services you provide:

Where did you receive your clubfoot training?

Please provide the contact details (Name and Email/WhatsApp number) of the doctor who performs tenotomies at your clubfoot clinic:

What scoring method do you use at your clinic to assess a clubfoot?

If you are human, leave this field blank.