Receive approval from your physician. This information varies depending on your insurance coverage. Downloadable forms can be printed and given to your physician for review prior to your exam. Once your physician has completed your exam and completed the required documentation you can fax the completed forms to Geritom at fax 952-854-1082 or you can call Geritom and request all forms be faxed to your physician prior to your next visit.

Once Geritom receives your completed forms we will be in contact to schedule your initial shoe fitting appointment.

Visit with your Geritom diabetic shoe team. At the initial shoe fitting the following will occur:

• Monofilament Test
• Foot Temperature
• Foot Impression
• Measurements of the Foot
• Shoe Style Selection

Upon completion, Geritom will order your shoes and inserts. This process will take about three weeks for your shoes and custom inserts to be manufactured and sent back to Geritom for the final shoe fitting. Once they arrive we will call you to schedule the final shoe fitting.

At your final shoe fitting you will try on your shoes and custom inserts to make sure they are comfortable and ready to wear. Your Geritom diabetic team member will be there to assist, have you sign your completion documents and walk you through your shoe instructions and break-in process.

A prescription that includes a diagnosis of diabetes and at least one of the six diabetic conditions. Your physician will need to sign and date this document.

• History of partial or complete amputation of the foot.
• History of previous foot ulceration.
• History of pre-ulcerative callus.
• Peripheral Neuropathy with evidence of callus formation.
• Foot deformity.
• Poor circulation.

Completion of the Statement of Certifying Physician Form for diabetic shoes. This form should include the diagnosis of diabetes and at least one of the six diabetic foot conditions. Your physician will need to sign and date this document.

• History of partial or complete amputation of the foot.
• History of previous foot ulceration.
• History of pre-ulcerative callus.
• Peripheral Neuropathy with evidence of callus formation.
• Foot deformity.
• Poor circulation.

A copy of the Face to Face Chart Notes (most physician offices use progress notes). These notes will come from your physician office. These notes should show that your physician has seen you within the last six months for your diabetes and diabetic foot condition.

Note: Medicare covers 80% of the cost of diabetic shoes and custom inserts. Your supplemental insurance picks up the rest. If your plan has a deductible or spend down that has not been met, it is the customer’s responsibility and you will be charged accordingly.

If your insurance coverage is Medicaid or other commercial plan they will require:

Completion of the Statement of Certifying Physician Form for diabetic shoes. This form should include the diagnosis of diabetes and at least one of the six diabetic foot conditions. Your physician will need to sign and date this document.

• History of partial or complete amputation of the foot.
• History of previous foot ulceration.
• History of pre-ulcerative callus.
• Peripheral Neuropathy with evidence of callus formation.
• Foot deformity.
• Poor circulation.

Note: If your insurance plan has a deductible or spend down that has not been met, it is the customer’s responsibility and you will be charged accordingly.