Referral - Officiële website Verbandschoenen

Upload your referral letter

Attention! Complete this form only if you have a valid referral

1. Contact details

We will use this e-mail address to update you on the status of your order.

Firstname(Required)

Lastname(Required)

Email(Required)

2. Shipping details

Enter the address where we should send the order to

Shipping details(Required)

3. Upload

Upload the referral you received from your GP.

Referral letter(Required)

Drop files here or

Max. file size: 512 MB.

Choose your model

Attention! Complete this form only if you have a referral

Model(Required)

Paris 1

Paris 2

Choose your size

Attention! Complete this form only if you have a referral

Size(Required)

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