Footscape

Footscape recognises disadvantaged persons may have difficulty accessing fundamental materials to maintain foot health. Accordingly Footscape is making available new footwear, new socks and foot care kits for disadvantaged persons with urgent clinical needs.

Requests for urgent material aid may be completed by Podiatrists and Orthotists employed by Primary and Community Health Organisations accredited with the Victorian Department of Health and Human Services on behalf of their clients. Applicants should refer to the Terms of Agreement listed below before proceeding with the request. Footscape will respond to submitted requests within two business days.

Request Form

Organisation *

Podiatrist/Orthotist *

Email address *

Material Aid Request *

Client Information

Please outline why your client requires urgent material aid from Footscape. Provide as much information as possible whilst maintaining patient confidentiality.

How is the client disadvantaged?*

Relevant medical history*

Podiatric history*

Clinical assessment*

Treatment plan*

Terms of Agreement:

The applying Podiatrist/Orthotist consents to bearing the responsibility for dispensing and monitoring the material aid item(s).

The applying Organisation agrees to attend to postage costs, unless a prior arrangement has been made.

Disclaimer:

Footscape Inc. will use submitted information for the purposes stated and for no other purpose. Information will be destroyed when it is no longer relevant for the organisation. Footscape Inc. compiles with Commonwealth and Victorian Government privacy legislation.

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