sole coaster

Name

Address and phone number

What is your disability or condition?

How much control do you have of your toes?

No control

Some control

Full control

Do your toes curl up and make it difficult to get your shoes on?

yes

no

sometimes

How do you deal with this problem?

Would you be interested in a product that could help with this problem?

Yes

No

Maybe

Definitely

Please share if you have or know of any products that are helpful.

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